In bud and in bloom at Roses!
POSTED 6/12/2016 (revised 10/18/2016) — I was hoping to post this notice along with a lot of new material I’ve been working on for this website, but poor health right now makes it impossible for me to proceed with this as planned.
During 2015–2016 (11 years after surviving my endometrical cancer of 2004–2005), I was diagnosed with two more cancers.
My second known cancer (a Stage 0 melanoma on the left cheek of my face) was surgically excised in stages, October 2015 through January 2016.
In April 2016 I began treatment for my third known cancer — a Stage III colorectal cancer, related to my earlier gynecologic cancer (and to the stress of my ongoing dispute with predatory neighbors in the adjacent subdivision). The arduous treatment regimen (chemotherapy, followed by multiple surgeries, followed by more chemotherapy) is expected to take at least eight months to complete. At one point, it looked as though I would not be able to get the treatment I needed for my Stage III colorectal cancer in San Diego, but that situation appears to have resolved itself now ... which is very good news for me (one less thing to have to worry about ;-).
I am having a hard time with the chemotherapy. In addition to spending too many days of the month in a chemically-induced stupor, experiencing the world in slow motion, my hands are cramped and arthritic, making it difficult to type and do my work. These physical limitations are supposed to be temporary, but while they are in force, they are wreaking havoc with my life, my research, and my schedule.
And it’s not just my life that has been turned upside-down by cancer. As observed by Terry Tempest Williams,
AN INDIVIDUAL DOESN’T GET CANCER,
A FAMILY DOES.
That I am able to function, period, during this difficult time, is due to my best friend & life partner — my husband, Ray — who has been with me every step of the way.
[ UPDATE posted on 12/13/2016 ]
The life-threatening illness in November–December 2016 of a family member, for whom I am responsible, has further delayed treatment of my colorectal cancer, already beset with complications. I hope to resume cancer treatment in January–February 2017.
[ UPDATE posted on 1/5/2017 ]
I was touched by the PBS NewsHour’s 1/4/2017 reporting on Iraqi civilians fleeing the battle for Mosul.
It’s hard enough dealing with uterine cancer under the best of circumstances. Imagine having to do it as a homeless, single mother living in a refugee camp for internally-displaced people in Iraqi-held Kurdistan. You have no support network on which to rely, because you have been forcibly separated from your husband by camp authorities, and given no information as to his whereabouts, his detention status, or his possible return. Not only are you dealing with the unknowns of cancer and a rootless future, you’re undergoing harsh and traumatic cancer treatment while having to fend for yourself and your children and elderly grandmother in an unfamiliar & unaccountable bureaucratic setting, while the battle against ISIS for control of your former home (city of Mosul, in northern Iraq) rages on. Civil war — within your body, as well as your community — tears at your family, limits your options, prevents freedom of movement, and tests your resolve, displacing any hope of gaining some semblance of control over your life with hopeless fatalism.
PBS NewsHour report by special correspondent Marcia Biggs and videographer Eric O’Connor, “Why Iraqi Boys and Men Are Disappearing amid ISIS Concerns” (originally aired 4 January 2017).
SUMMARY: “For nearly three months, Iraqi forces backed by the U.S. have been fighting to retake the ISIS-held city of Mosul. The militants still hold much of the city and its nearly one million residents. ¶ Almost 130,000 people have fled Mosul since the battle began. Security officials are now trying to harbor the displaced, while also containing the spread of ISIS. But the process of screening and detaining men and boys who have left to ensure they are not extremists is fraught and controversial. ¶ From Northern Iraq, special correspondent Marcia Biggs and videographer Eric O’Connor report.”
Biggs and O’Connor profile Mosul refugee and gynecologic cancer patient, Miad. Some excerpts from the NewsHour website’s transcript for the video podcast follow.
1. “MARCIA BIGGS: [...] Back in the camp, 27-year-old Miad shows me the only picture she has of her husband, Ramy. She says they had been here for 10 days when he went to camp security to get permission for her to see a doctor. He never came back.
“MIAD, Lives in Camp (through translator): The night that they arrested him, I waited up until midnight, but he didn’t come. I went to the camp manager. He said it’s a normal investigation, and he will be back soon, it will only take a couple of days. That was 17 days ago. ¶ I remember they put his name in the database two times, and they didn’t find anything on him. He was cleared. He doesn’t have anything to do with ISIS.
“MARCIA BIGGS: She’s here alone with her two children and her 80-year-old grandmother. Diagnosed with uterine cancer, she has special permission to go to her chemotherapy appointments, but like everyone else, is otherwise forbidden to leave the camp.
“MIAD (through translator): I went to the camp security and he didn’t give me any information. They just told me, if he is innocent, we will bring him back to you. If he’s guilty, don’t ask about him.” (n. pag.)
2. “MARCIA BIGGS: Miad says she now wishes she had never left Mosul.
“MIAD (through translator): I need my husband by my side. When I am sick, he takes care of the kids, and makes sure we have food. But now I have no one, only God and my two kids. My life here is very hard. If I had known they would arrest my husband, I never would have left my village.” (n. pag.)
3. “MARCIA BIGGS: Half-an-hour later, we were at a former ISIS bomb factory looking at some vehicles that ISIS left behind. We were hustled to a nearby home to wait out the shelling. ¶ So we just received a mortar from around five to six kilometers away. The general believes that perhaps one of the civilians that saw us talking to all of the neighbors may have given information to ISIS that we were here, which is why we have received this mortar. ¶ There is no way to know for sure if someone informed on us, but it is a reminder that, even in so-called liberated areas, there is still a very real war being fought. Those who choose to stay may keep their homes and their dignity, but they now live in a state of limbo between ISIS and the Iraqi army, and with that comes suspicion and danger. ¶ Eight more rounds hit areas around us that afternoon. This local villager emerged from his home carrying a white flag and begging the army to let him take his family to the next village. He was told to stay in his home. ¶ Back in the camp, Miad may be out of the line of fire, but she faces every day alone, no information, no answers.
“MIAD (through translator): God willing, he will come back to us. I am not the only one. Too many others have been taken who have nothing to do with ISIS.
“MARCIA BIGGS: For now, all she can do is wait. ¶ For the PBS NewsHour, I’m Marcia Biggs, outside Mosul, Northern Iraq.” (n. pag.)
The increasingly oppressive situation for women in this war-torn region, even in Iraqi-held Kurdistan where the Kurdistan Workers’ Party (or P.K.K.) has “long made women’s rights a centerpiece of its political platform,” is underlined by recent government assaults on Kurdish women’s rights in many heavily Kurdish areas of eastern Turkey.
POSTED 3/15/2015 — I am usually pretty resistant to the siren song of technological exploits in all fields, especially medicine, having long ago adapted for my own purposes the motto of Cornelis Drebbel (1572–1633), advocating a wise use of technology & automation: “Use Thy Gifts Rightly.”
But Birmingham University researchers’ work with what I have taken to calling the music of cancer struck me as just too cool to ignore. Rather than waiting for the launch of our new section on the evolving role of technology & automation in U.S. health care, I decided to pass on the relevant information now:
“Detecting Cancer by Sound: Doctors—and you, too—can listen to difference between healthy and malignant cells,” posted by Josh Fischman to the Scientific American website on 17 February 2015
Includes 4 audio clips for comparing the sound signatures of healthy vs. cancerous cells.
The above posting by Fischman is a companion piece for the original print edition of
“Sound Bytes: Ears are such terrific pattern finders that scientists are using audio data to detect cancer cells and particles from space,” by Ron Cowen, for the March 2015 issue of Scientific American (vol. 312, no. 3, pp. 44–7)
NOTE: a fee-for-view applies, unless you have a paid subscription (which many university libraries provide).
A digital copy of the March 2015 issue of Scientific American, which is themed around “Electric Cures” (“The Battle Within and Without for Healthier Lives”), costs USD $6, and you can purchase it here.
According to Cowen, the traditional — visually-oriented — laboratory procedure for analyzing biopsy samples requires nuanced interpretation and is time-consuming:
In the usual procedure, known as Raman spectroscopy, a pathologist shines infrared laser light on cells sitting on a slide, and the light’s energy prompts molecules in the cells to vibrate. Different molecules vibrate in different ways, and the vibrations shift the frequency of photons scattered back from the sample. The spectrum of color in the scattered light coming back from them is a fingerprint that identifies the molecular properties. Some molecules, part of abnormal proteins in cancers, have different fingerprints than normal proteins do. The visual differences are subtle, however, and it takes time and expertise to determine if the cells are healthy or not.
Subtlety, of course, is an auditory specialty. “The human ear is naturally trained in spotting patterns and regularities and is much better than the eye in recognizing them,” says Stables’s collaborator Domenico Vicinanza, a physicist and musician at DANTE, a European consortium in Cambridge, England, that builds and operates high-speed networks for research and education. For instance, Vicinanza says, the eye cannot tell the difference between a light that blinks 30 and 60 times a second, but the ear can distinguish a source of sound that vibrates 30 and 60 times a second.
(R. Cowen, “Sound Bytes,” 47)
Because “In the U.K. health system, there is a very long wait between taking a biopsy from a patient, sending it to a lab, and having it analyzed and sent back,” Ryan Stables, a musician and digital-media technologist at Birmingham City University, “got the idea of transforming a visual technique of identifying cancer cells into an audio method.” (R. Cowen, “Sound Bytes,” 47)
Early tests of Stables’ sonified spectra have shown lots of promise.
In tests, about 150 clinicians were given 300 sound files, each representing a different tissue sample. According to Stables, the clinicians correctly discerned differences between the samples about 90 percent of the time. He and his colleagues reported this work last June at the 20th International Conference on Auditory Display in New York City. Within a year, Stables says, the team expects to begin testing its sonified spectra in doctors’ offices.
Stables also believes this method could make its way into the operating room, giving physicians fast feedback during surgery about whether they have removed all cancer cells or whether some remain. To make this work, the spectroscopic analysis has to be done quickly, sonified and broadcast into the operating room. That means Stables and his colleagues not only have to choose tones, pitches and timbres that preserve the character of the original spectrum but also create sounds that are pleasant.
“If you’re doing some kind of high-precision surgical procedure, you don’t want [to] have this distracting, constant ringing in your ears,” Stables says. “It is very difficult to find a balance between making the signal nondistracting and yet preserving the quality of the data that are actually relevant to discerning the differences between two types of tissues or cells.” But his tests with clinicians indicate that the sonifiers have found a good balance.
(R. Cowen, “Sound Bytes,” 47)
Presumably, this means that computers running sophisticated pattern-recognition software — a form of artificial intelligence capable of analyzing frequency and amplitude data even faster and better than the human ear — will make even more promising diagnosticians when it comes to detecting the sonic patterns of cancer.
For more on Dr. Ryan Stables, the lecturer in audio engineering and acoustics at Birmingham City University who produced the cancer cell tones, see:
“Training Computers to Understand the Language of Music,” by Michael Eyre, Science Reporter for BBC News (posted to the BBC News website 10 September 2014)
[ UPDATE posted on 7/4/2016 ]
Another long-neglected sense useful in detecting cancer is smell. For years, we’ve heard anecdotal accounts of people’s pets alerting them to cancer, and researchers have begun studying trained dogs’ ability to detect the smell of cancer — including ovarian cancer — in hopes of developing electronic sensors that can sniff for cancer as well as dogs do.
PBS NewsHour report by special correspondent Dr. Emily Senay, “Can Dogs Be Trained to Detect the Smell of Cancer?” (originally aired 6 September 2014)
SUMMARY: “For the past few decades, researchers have been exploring the possibility that cancer, possibly created by the growth of tumors, actually has a particular odor — and dogs can pick up on that smell. Some doctors believe this area of research may lead to more efficient screening methods and cancer treatment procedures. Special correspondent Dr. Emily Senay reports.”
“At the Penn Vet Center ... [a] team of four dogs like Tsunami, a German Shepherd and Foster, a Labrador Retriever are being trained to detect blood samples from ovarian cancer patients. Ovarian cancer kills more than 14,000 women in the US each year and is especially hard to detect in early stages.” (Senay, n. pag.)
“Doctor Otto acknowledges that training cancer detecting dogs is time consuming and expensive at more than thirty thousand dollars a dog each year- and dogs can only identify a limited number of samples each day. But she sees her research eventually leading to a more efficient screening tool.” (Senay, n. pag.)
“CYNTHIA OTTO: I think that it’s good to have skepticism. I think what we’re learning is that not all dogs can do this. It takes special training. But I also agree completely that dogs are not gonna be in the hospital laboratories, sniffing samples. Our goal with the dogs is to help direct where– how we can build a better screening tool. ¶ The dogs themselves probably aren’t gonna do the final job. They’re helping us design the tool that will then become the screening tool. Something that is more automated, something that is inexpensive and can screen thousands of women, millions of women a year.”
Senay continues: “That’s where Doctor Charlie Johnson comes in. He’s a physicist at the University of Pennsylvania using nanotechnology to develop what amounts to an electronic nose capable of smelling cancer. So one day his device might be programmed to measure the gases and compounds emitted from tumors that Doctor Otto’s dogs are smelling.”
“Returning the Favor: Who’s Really Saving Who?” by Kelli Harmon (Best Friends Magazine, January/February 2014, 30–35). Because this issue of the magazine is not included in Best Friends Animal Society’s online archive, I have provided a digital reissue of Harmon’s “Returning the Favor: Who’s Really Saving Who?” here.
The article opens with an anecdote about a cancer-sniffing rescue cat named Leo, and closes with a profile of Dina Zaphiris, who trains rescue dogs to detect cancer through her InSitu Foundation: “In Situ’s mission is to start in the shelters and rescues, choosing dogs that don’t have homes. In Situ rehabilitates, and then trains these dogs to detect cancer.”
Zaphiris also focuses on using dogs to sniff out ovarian cancer. “While Dina was initially interested in medical scent detection as another form of dog training, in 2010 it became personal, when she lost her mother to breast cancer. That year, she started InSitu Foundation, which is dedicated to training dogs to detect cancer in humans. In their most recent study, Dina says, ‘We trained nine dogs to detect early-stage ovarian cancer. We haven’t published the results yet, but during training, the dogs’ accuracy levels were up in the high nineties — and that’s for ovarian cancer, for which there are (currently) no detection methods.’ ¶ Dina’s goal is to see a day when dogs’ scent abilities are accepted and used for routine cancer screening. She hopes that someday it will be standard procedure for doctors to take breath samples from patients and send them to a lab to be tested — by dogs. Dina says, ‘(This method) provides a noninvasive, low-cost, really accurate method of finding cancer early. We need more studies and we need to get this standardized. We could be saving lives. Within five years, we’re going to have a breath-screening kit for cancer. We will do it.’” (K. Harmon, 35; click/tap here to read the full text of Harmon’s article)
Ultimately, “Dina’s goal is to open a low cost or free cancer screening facility, where these cancer-scenting dogs could save many lives. That is her dream. The study is also leading scientists to the development of the mechanical nose, which will try to mimic the capabilities of the dog nose.” (from http://dinazaphiris.com/cancer-detection/; accessed 6/30/2016)
“What a Smell Looks Like,” by Nsikan Akpan, digital science producer for PBS NewsHour (posted to the PBS NewsHour website 9 June 2016)
This piece is not about smelling cancer, but about new techniques for visualizing smell that are helping scientists better understand this evolutionary sense. Whether or not their research has fallout for medical scent detection training, it is very cool.
“‘Smell was part of very ancient evolution,’ said COC teammate Katherine Nagel, an electrophysiologist at New York University who is exploring how fruit flies turn in response to smell. ‘Bacteria use olfaction, single-celled organisms use olfaction, worms use olfaction.’ ¶ This utility expresses itself as behavior. Sweet smells draw bees to flowers, fueling pollination and the survival of crops. A wandering albatross can sniff a piece of floating carrion from three miles away, while sulfur compounds found in decaying animals were once added to 40-mile gas lines, so turkey vultures and their giant beaks could be used to spot leaks. Adult salmon cross hundred of miles using olfactory cues to find and spawn in their place of birth. ¶ The team is studying various animals to unpack these behaviors. Lucia Jacobs, an evolutionary ecologist at the University of California Berkeley, is examining rescue dogs to see how their skills stack against other super smellers, like hermit crabs and cockroaches. Urban and Pitt mathematical neuroscientist Bard Ermentrout use infrared lights to track the whiskers of mice as the rodents follow odor trails. Ermentrout can then program those instincts into computerized mice. ¶ ‘Can we create smell-o-vision or a smellbot? I don’t know. What we’re really trying is to understand mechanistically how the brain works,’ Crimaldi said. ‘We don’t necessarily know what we’re going to find. That’s exciting part of it.’” (N. Akpan, n. pag.)
POSTED 11/24/2014 — I was pleased to see Saturday’s PBS NewsHour report covering the legacy of colonial violence in modern indigenous communities. It brings to our attention, once again, the appalling amount of sexual violence committed against American Indian and Alaska Native women, along with the subsequent injustice they face when attempting to right a grievous wrong.
PBS NewsHour Weekend signature segment, by Stephen Fee: “‘Above the law’: Responding to domestic violence on Indian reservations” (originally aired: 22 November 2014)
SUMMARY: “Native women in the U.S. face some of the highest levels of violence of any group. The Justice Department says acts of sexual assault against Native American women are most frequently committed by non-Indian men, who are generally immune to prosecution in tribal courts. Congress reauthorized the Violence Against Women Act last year, which gave tribal courts jurisdiction over certain domestic violence crimes committed by non-Indians. But advocates say acts of sexual violence on Indian reservations are still happening with few consequences. NewsHour Weekend’s Stephen Fee reports.”
I see this as an important public-health issue, as well as one that is entwined with the centuries’-old debate over militarism and the culture of violence in America which I first raised here back in May (see below, entry dated 5/9/2014).
Knowledge that “a legal maze allows sexual predators to attack American Indian women with impunity” gained its first toe-hold in the public consciousness back in April 2007 when Amnesty International issued its report, “Maze of Injustice: The Failure to Protect Indigenous Women from Sexual Violence in the USA.” A summary account of the report’s contents appeared that same year in the journal ColorLines: The national newsmagazine on race and politics. Written by Kari Lydersen, the newsmagazine article explained that
One of the main problems is that American-Indian courts cannot prosecute non-Indian offenders, because of a 1978 Supreme Court ruling called Oliphant v. Suquamish. Federal courts—and in some states, state courts—can prosecute crimes committed on reservations. But in the case of rape and sexual abuse, federal and state prosecutors tend to ignore the problem or blame the victim, and a lack of resources and cooperation from tribal police and tribal health authorities makes the task even more difficult.
The majority of alleged rapists on reservations are non-Indian, according to the report. Disturbingly, it suggests these perpetrators are well aware of the fact that they are highly unlikely to be prosecuted for their crimes and hence intentionally take advantage of the opportunity, creating a “breeding ground for sexual predators.”
“The U.S. federal government has created a complex interrelation between these three jurisdictions (tribal, state and federal) that undermines equality before the law and often allows perpetrators to evade justice,” according to the report. “In some cases this has created areas of effective lawlessness which encourages violence.”
(K. Lydersen, “Rape and the Reservation”, ColorLines, Nov./Dec. 2007, vol. 10, no. 6, p. 37; click/tap here to read the full text of Lydersen’s article)
“Not surprisingly,” continued Lydersen,
these conditions mean women at Standing Rock and other reservations are highly reluctant to report rapes, and they are also unlikely to get crucial medical and psychological attention. Even when rapes are reported, there is a serious dearth of resources for victims at Indian Health Service facilities.
(K. Lydersen, “Rape and the Reservation”, ColorLines, Nov./Dec. 2007, vol. 10, no. 6, p. 37; click/tap here to read the full text of Lydersen’s article)
ColorLines reported again on legislative attempts to redress some of the inequities which perpetuate the high sexual assault rates and violence against indigenous women in 2010:
“Indian Country Wins Power to Fight Sexual Assault,” by Michelle Chen (posted to the ColorLines website, 2 August 2010)
SUMMARY: “Congress has just given Indian Country greater authority to police its own, and that may be good news for women. [T]he Tribal Law and Order Act, which was signed by President Obama last week [on 7/29/2010], expands the authority of tribal criminal justice agencies to prosecute crimes within their own territory, rather than relying on the notoriously spotty federal authorities. While the emphasis is on policing, advocates have hailed the bill as a step toward alleviating the often hidden epidemic of sexual and gender-based violence against Native women.”
“More effective prosecutions can help alleviate the most regressive aspects of the tribal government system. Activists can now look to the other systemic changes needed to treat and prevent gender-based violence—a paradigm shift in Indian country that moves women out of the box of victimhood [and] gives them a real voice in how they, and their violators, are treated.”
Other indigenous women began to speak out against “the plague of sexual assault in their communities,” including Mary Annette Pember, a Red Cliff Ojibwe and independent journalist whose work focuses on American Indian issues:
“Silent No More: Native Women Seek Healing from Sexual Assault,” by Mary Annette Pember (The Progressive, September 2010, vol. 74, no. 9, pp. 26–9)
As Lydersen had earlier pointed out in 2007, the epidemic of sexual assault in today’s native communities is rooted in the very colonial violence Thomas Tryon warned against in 1684:
The Amnesty International report [of 2007] places its conclusions within the context of the legacy of U.S. governmental and societal abuse of American Indians. The report notes that prior to colonization, gender-based violence was rare and severely punished. But settlers regularly engaged in sexual violence as part of the conquest of Indians. And Christian missionaries and government officials dealt primarily with men and pressured tribes to mirror the white family structures, “profoundly chang[ing] gender roles among indigenous people.”
“Sexual assault rates and violence against Native American women did not just drop from the sky,” said Jacqueline Agtuca at a 2005 conference of American Indian women in Alaska. “They are a process of history.”
(K. Lydersen, “Rape and the Reservation”, ColorLines, Nov./Dec. 2007, vol. 10, no. 6, p. 38; click/tap here to read the full text of Lydersen’s article)
Before closing, I would like to point to one more article which brings the voices of diverse American women warriors to bear on our historical debate over militarism vs. wise use of military force:
“Home from the Military: A third of female veterans are women of color. Here are three of their stories,” by Michelle Chen (ColorLines, July/Aug. 2008, vol. 11, no. 4, pp. 16–21)
Among the 3 women profiled here is Eli PaintedCrow, Iraq war veteran and co-founder of SWAN (Service Women’s Action Network), “an organizing project focused on active-duty and veteran women.” (M. Chen, 21)
When PaintedCrow retired after Iraq, her body bore the scars of a uterine problem that had been left untreated, and her mind reeled with depression and anger. As she strained to regain stability, her younger son struggled with a brain injury suffered while he was in the military. But the VA claim process dragged on for so long, she said, she resorted to public assistance in the interim to support herself—returning to the same poverty that had pushed her to enlist a generation earlier.
In remote native communities, PaintedCrow said, veterans contend with broken social service systems, while VA programs in many areas ignore healing methods rooted in indigenous cultures, like traditional ceremonies and sweat lodges.
(M. Chen, “Home from the Military,” ColorLines, July/Aug. 2008, vol. 11, no. 4, p. 20)
According to Chen,
Fusing self-expression with activism has helped PaintedCrow salve her battle wounds. She is currently [i.e., in 2008] organizing Turtle Women Rising, a pro-peace gathering to be held in Washington, D.C., in October. Led by indigenous women, the event will center on prayer and traditional concepts of healing.
She distinguishes between peace initiatives and mainstream antiwar campaigns. In her view, conventional activists have fixated on criticizing the current administration’s policies and promoting a “for or against” mentality, rather than raising consciousness about underlying inequities that sow military violence.
PaintedCrow and other SWAN activists trace a different front line, stretching from embattled Iraqi villages to blighted American streets. “The problem lies in many places,” she said. “The problem lies in the racism that is still in our nation. The problem lies in the separation of issues.”
In indigenous communities, she noted, many youth enlist in hopes of rekindling their past warrior traditions. But, having witnessed both sides of the military’s human toll, she said, “I think it’s another illusion that they value, that being a warrior and a soldier are the same. A soldier takes orders. A warrior does things with heart.”
(M. Chen, “Home from the Military,” ColorLines, July/Aug. 2008, vol. 11, no. 4, p. 21)
PaintedCrow’s traditional values and perspective offer an interesting alternative to early colonial ideals of femininity, which ignored women’s role in warrior culture; to our modern fixation with “single-issue politics”; and to our ongoing romance with militarism, which encourages decoupling the “violence and economic stratification in ... communities [from] the inequalities girding the military system” (M. Chen, 21).
POSTED 9/30/2014 — I have been stockpiling a great deal of new content for Roses, while I intently work on several other projects which I hope to complete by the end of this year. However, the following information is time-sensitive — presenting me with a kairic moment I couldn’t ignore. Californians need to know now about this important development in our state’s implementation of Obamacare (aka the Affordable Care Act), because it will affect enrollments this fall (open enrollment runs from 11/15/2014 through 2/15/2015):
“Obamacare Networks to Stay Limited: Despite consumer complaints, insurers will keep a lid on doctor choices in 2015,” by Chad Terhune, Sandra Poindexter, and Doug Smith (Los Angeles Times, 28 September 2014, pp. A1 and A18–A19)
IN SUM: As “insurers prepare to enroll hundreds of thousands of new patients this fall and get 1.2 million Californians to renew their policies under the Affordable Care Act,” California’s “largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state’s insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans.” (p. A1)
According to Sabrina Corlette, research professor at Georgetown University’s Center on Health Insurance Reforms, “the continued emphasis on narrow networks and a lack of clear information portend another challenging year for consumers” relying on Obamacare: “It’s been a low priority for insurance companies to maintain these provider directories, and states really aren’t pushing back on narrow networks.” (Corlette, qtd. p. A18)
Indeed, California’s insurance exchange “endorses the industry’s narrow network strategy as a way to keep premiums affordable. The state has credited it for helping produce two straight years of lower-than-expected premiums for individual coverage. Rates for 2015 are expected to increase 4.2%, on average.” (p. A18) This cost-containment strategy is defended by Peter Lee, executive director of Covered California, who argues that “rates are just part of the equation and the exchange carefully examined these proposed networks to ensure patients aren’t being shortchanged.” (p. A18)
Less defensible is the fact that “There’s no timetable for a state provider directory after the exchange scrapped an initial version that was riddled with errors. Instead, Covered California refers people to insurance company websites that vary in usefulness.” (p. A18) To counter this, and help Californians answer the twin questions “Can I keep my doctor with Obamacare?” and “Does this physician take Covered California?” Los Angeles Times reporters have “created a statewide database of 80,000 doctors and medical providers participating in Covered California individual coverage for 2015. Patients can now search by name, location, specialty and participating health plan at: latimes.com/obamacaredoctors. ¶ The database draws on insurance company information submitted to state regulators and obtained under the Public Records Act. ¶ The information, for individual coverage only, is current through August and subject to change before coverage takes effect Jan. 1. Details should be verified with a health plan.” (p. A19)
alternate (direct) link to Database of more than 80,000 providers available for 2015 Covered California health plans, compiled by Sandra Poindexter, Doug Smith, Chad Terhune, and Ben Welsh of the Los Angeles Times (28 September 2014)
An added enticement: There are maps, too!
A hearty thanks to the Los Angeles Times — and all the reporters responsible for that newspaper’s excellent in-depth coverage of California health-care issues — for this important public service.
NOTE: Taking advantage of this brief distraction from my other work, I’ve also added 4 links (for August and September 2014 reporting) to the media coverage section of our FYI page entitled “Amazon.com Drops Its California-Based Affiliates, Including this Website.” Unlike other pages at Roses, this Web page tracking the fallout from Amazon.com’s predatory business model is still easy to update, and so I did.
POSTED 5/9/2014 (revised 6/5/2014 and 6/30/2014) — I am happy to announce another original Roses digital edition: the first debate over gun control in America, entitled The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., authored by the extraordinary polymath, Thomas Tryon (1634–1703), and originally published at London in 1684.
I wasn’t planning to release this title so soon, but have decided to adjust our publication schedule yet again, moving this late-17th-century book to the fore, in response to a contemporary news item that I believe warrants special attention:
Los Angeles Times editorial, “Why NRA Opposition Shouldn’t Doom Obama’s Surgeon General Nominee: The group is wrong to attack Dr. Vivek Hallegere Murthy over his support for gun control,” published in the 23 March 2014 paper, p. A17.
Lisa Mascaro’s original reporting of the story — “NRA vs. Nominee for Surgeon General: Democrats aren’t sure President Obama’s pick can win enough votes from pro-gun senators in their party” (Los Angeles Times, 16 March 2014, p. A11) — is also available at the newspaper’s website, retitled “NRA Opposition May Sink Obama’s Surgeon General Nominee: Senate Democratic leaders are trying to determine whether Dr. Vivek Hallegere Murthy has enough support. As some pro-gun Democrats break with the president, the White House declines to push for a vote.” for online posting.
Predictably, reactions to the online edition of the 3/23/2014 LA Times editorial by pro-National Rifle Association commentators stress the newspaper’s liberal extremism. Remarks such as
... Typical anti-gun liberal writers from the L.A. Times....
(posted to the Los Angeles Times website by DMAC0331)
Forget the NRA’s opposition. What is key is that this man is an extremist Progressive Democrat who has a political agenda that is more important to him and to this Administration than the medical care of Americans, which is the Surgeon General’s job, not politics.
(posted to the Los Angeles Times website by tommythek501)
A candidate for surgeon general apparently believes that people shooting each other with guns is a public health issue. Guess we should expand the role of public health to auto accidents. After all, more people are killed in car accidents than by guns every year. Maybe we should ban cars or put the speed limit at 25 mph. If the concept of public health can be expanded to gun control, there’s no limit to what public agencies can decide to regulate, ban or control by calling it a ‘public health’ issue. People find ways to be stupid and kill themselves or others by various means. What public health should be doing is looking at disease prevention, sanitation, education about disease, treatment of disease. The NRA is right to oppose this doctor who seems to want to set himself up as a little statist, expanding the meaning of public health to cover all outdoors.
(posted to the Los Angeles Times website by Dorothy Myers)
typify this point of view.
Less well-known, apparently, is the fact that American debate over gun control as a public health issue antedates “liberal” and “leftist”/“socialist” parties in the United States — as well as the U.S. Constitution (ratified 21 June 1788), and the Second Amendment (adopted on 15 December 1791) — as evidenced by Tryon’s The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ... of 1684, in which he argued passionately for gun-control legislation as part of a larger dissenting vision of the Anglo-American, new-society project then underway in North America.
Addressing himself to newly-planted colonists in the large tract of land west of the Delaware River, Tryon hoped that his treatise would inspire the godly to return to their Christian humanist roots.
He and other transatlantic independent reformers felt that “our New-Building” of a Christian society, especially as modeled in the plantation of New England, had lost its way.
But the Pennsylvania settlement was still young (the first Pennsylvania charter was drafted in March 1681 when Pennsylvania became William Penn’s proprietary colony, and was modeled on the West New Jersey concessions and agreements that Penn had negotiated while a trustee for West New Jersey). The area around what would become Delaware (which Penn also obtained as part of the crown’s colonial grant) was populated by a diverse mix of Europeans (Swedes, Finns, Dutch, and English) who had already built an export trade in tobacco, proving that the fledgling colony had commercial potential. And Pennsylvania’s first government was constitutionally committed to religious tolerance and inclusive political participation. As such, Tryon felt there was ample opportunity here to adjust course and get the “holy experiment” right.
In The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., Tryon suggested that Pennsylvania and New Jersey colonists look to an alternative prelapsarian model of society, grounded in the Christian message of love & light (wisdom), where all “Oppression and Violence” — including “the use of Guns, Swords, Powder, Shot, or the like Engines and Utensils of War” — are vanquished by “Law and Custom.”
Several of Tryon’s arguments on behalf of this vision were prescient. For example,
Furthermore, though you will not kill those of your own kind, yet your Children seeing and learning these Preparations of Oppression and Violence, they may come to be of different Opinions, and by degrees kill one another with their Fathers Guns and Swords; for we know not what sort of People will come after us, nor what Spirit they may be of: Therefore it will be highly convenient for us to prevent the Growth of all Fierceness, Wrath and Violence, even in the bud, by our Laws and wholsome Customs; for there is no way or means that can or will so powerfully disarm the Rage of Men and other Creaturs, as Clemency and Well-doing.
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 21)
To Tryon, the implications of such social reforms, both for physical and spiritual health, were evident:
... Man often finds himself in great Trouble and Discontent, and wonders very much what may be the occasion thereof; not considering the true cause, viz. That their Hearts and Souls do move in the fierce Wrath, and that they do not do unto all as they would be done unto, nor live in Innocency and Concord with all Creatures, which is the true Christian Doctrine. Therefore to prevent all these Troubles, Dangers and Annixities [anxieties], it will become us to be wise and Innocent in our Laws and Customs, that our Youthful Settlements [the North American colonies] may be a means to preserve us and our Posterity, and then our Childrens Children will bless our Souls, and we shall as naturally attract the sweet Influences of the Coelestials, and also the benevolent Aspects of all Creatu[r]es, as the Load-stone doth Iron; for every Like draws to its self its Likeness; for therein consists its highest Joy.
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 23)
Tryon’s nuanced, biblically-based argument for gun control is way more radical than anything being proposed today, including former Supreme Court Justice John Paul Stevens’ call for rewriting the Second Amendment to the Constitution:
“How Retired Supreme Court Justice Stevens Would Amend the Constitution,” Judy Woodruff’s interview with Justice Stevens for the PBS NewsHour (originally aired: 21 April 2014)
SUMMARY: “Former Supreme Court Justice John Paul Stevens talks to Judy Woodruff about his new book, Six Amendments: How and Why We Should Change the Constitution. In his book, the 94-year-old liberal justice calls for major changes to the Constitution on issues such as the death penalty, firearms, redistricting and campaign finance.”
Their brief discussion of “what this country should do about guns” comes towards the end of the interview when Woodruff asks: “You would change the wording of the Second Amendment to the Constitution to say the right of people to bear arms to own a gun should apply only when serving in the militia. ¶ Is it your ultimate hope that there would be no right to own a gun for self-defense?”
To which the former Justice responds: “Well, it would be my ultimate hope that legislatures would decide the issues, and not be hampered by constitutional restrictions, because, clearly, legislators are in a much better position than judges are to decide what could be permissible in different contexts. ¶ And the effect of the Second Amendment as it is now construed is to make federal judges the final arbiters of gun policy, which is quite, quite wrong, I think, and quite contrary to what the framers intended when they drafted the Second Amendment, to protect states from the danger that a strong federal armed force would have been able to [deprive] the states of their own militias.”
And this centuries-old appeal to the conscience of a nation by a conservative, deeply religious godly protestant like Thomas Tryon contravenes the National Rifle Association’s caricature of all gun-control proponents today as without precedent or legal justification — therefore un-American at their very core — misguided do-gooders, cultural élitists, and socialist-leaning aspiring despots, gleefully trampling on individual liberties.
In fact, gun control “is no new upstart conceit” (phrasing from T. Tryon, A Dialogue between an East-Indian Brackmanny or Heathen-Philosopher, and a French Gentleman concerning the Present Affairs of Europe, 1683, 21).
Were he alive today, Tryon would be appalled at the growing amount of domestic violence in 21st-century North America. Of note, Tryon raised the issue of guns and gender and cultural conditioning in The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., suggesting that a more girly education for all in England and Anglo-America would be an improvement, and more conducive to a society governed by the “Laws of Innocency”:
Let it be a Law and Custom amongst us, not only to abandon the use of all Weapons of War, but also to avoid all Attempts and Beginnings of Violence, as not to suffer any to use Cruelty unto, or to Hurrey and Oppress any of the Inferiour Creatures. This may seem a small and light thing, but really the Consequences of it are very great; for this will disarm the Rage of our Young People, and give their greener Years a settled Tincture or Habit of Love, Compassion and Concord. Have you not often seen in our own Country, little Children, almost as soon as they are able to take up a Stone or any other Weapon into their Hands, fling it at some Bird, or other innocent Creature, and to take delight in hanging, drowning or tormenting young Cats or Dogs, or any thing else that they can master; which evil Inclinations to Violence proceed partly from their Birth, as being begot from Wrathful Essences, and the like bad Qualities predominating in their Parents, and partly from Imitation; for the daily Practice and Examples they behold of Cruelty and Violence offered to all Creatures by their Fathers, stirs them up to do the like as far as their Power will reach to do Mischief. For this cause most Boys whilst they are in tender years do delight in Drums Swords, and all Weapons of Violence, because they see their Fathers and the Elder sort of their Sex do the same. But on the contrary, Female Children delight themselves in sewing of Linnen, Needle-work, playing with Babies, making of Banquets, imitating Christenings, (as they call them) and the like, in Imitation of their Mothers, whom they see much concerned in such Affairs. Since therefore whatsoever you do, your Youth will certainly endeavour to imitate; and for that there is as well a Possibility of awakening, strengthening and encouraging Innocence, Compassion, Patience, Concord, good Will and harmless Inclinations in all Youth, by the Practise and Custom of Well-doing, as there is of breeding and encouraging Wrath and Violence by evil Practices and Conversations: Therefore it will be good to season your Children’s first Years with Customs tending to Virtue and Innocence; in order to which, nothing will be more Prevalent than good Examples.
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 28–30)
Alas, gun violence against women is now so prevalent that it has become a major health issue for American women. See, for example:
The Women’s Health Activist cover story by Yvonne Crasso, “My Sister’s Keeper: Working to reduce domestic violence and gun violence,” from the March/April 2014 print issue, vol. 39, no. 2, pp. 1, 3 and 5.
Americans for Responsible Solutions project, founded by former U.S. Representative Gabrielle Giffords and her husband, retired Navy Captain and astronaut Mark Kelly.
“New Mass Murder, Old Lesson: Why we avoid talking about the one thing that might stop the next bloodbath,” by Richard Kim (The Nation, 23–30 June 2014, vol. 298, nos. 26 & 27, pp. 10–11).
Kim is here responding to the most recent sensationalized mass shooting, which took place in Southern California on 23 May 2014 — less than 3 weeks after I first posted this entry — and for which the shooter “went to great lengths to create a digital record of his alienation and rage, most of which was directed at women” (Kim, 10).
“#YesAllWomen Changes the Story of the Isla Vista Massacre: The struggle over the meaning of one man’s killing spree may prove to be a watershed moment in the history of feminism,” by Rebecca Solnit, posted to The Nation website, 2 June 2014.
Solnit notes here that “In 1990, the Journal of the American Medical Association reported, ‘Studies of the Surgeon General’s office reveal that domestic violence is the leading cause of injury to women between the ages of 15 and 44, more common than automobile accidents, muggings, and cancer deaths combined.’” (n. pag.)
Long ago, Tryon made the connection between “Abusers of Women,” “Private and Publick Murtherers,” and “a numerous Mob and mixed Multitude of Unclean Vermin, Rapacious Beasts, or worse” who threatened a godly social order:
These Thundring Bloody Multitudes also are always prompt and ready on every occasion, when Troubles and Ruptures happen in Governments, or whensoever Princes call them forth, and are well arm’d with inward and outward Principles to perform all manner of Bloody Employments. Also these Savages presently start up whenever the Reins of Government are slacken’d or withdrawn, and are ready with their Invading Plundering Powers to destroy Men Women and Children without any Mercy or Regret, and to ransack burn and destroy with as much Inhumanity and Licentiousness, as any ill paid Armies are when they have the Word of Command from their Generals: All fall Victims to their Heady Boisterous Passions and Tumultuous Rage. They turn adrift all Admonitions, and if any one offers to reprove and give Sober Advice, or bid them be modest and moderate, he’s knock’d on the head for his pains ....
(T. Tryon, The Knowledge of a Man’s Self the Surest Guide to the True Worship of God, and Good Government of the Mind and Body, 2 vols., 1703–4, 2.145–6)
Even more depraved than murderers and rapists, in Tryon’s judgment, were those involved in “the Trade of War and Destruction” — ungodly “Dark Mathematical Artists” who “blow up Men by Whole-sale” and profit from violence. In an essay entitled “Of Covetousness, Violence and Pride,” Tryon characterized weapons manufacturers as “doctors” of death — practitioners of the “Black Arts” and “Violators of the Creator’s Laws, who act under the Power of Covetousness and Violence”:
In the next place follows a long Train of Black Artists, which are as Mathematical Subjects belonging to Covetousness, Violence and Pride, whose business it is to furnish those their mighty Governors with apt and proper Materials wherewith they may manage and bring to pass their Wicked Violent Enormous Undertakings. These work in the Dark Side of the Mathematicks, and are so zealous and studious, that they leave no Stone unturned, nor Dark Corner unsearch’d, to find out apt Methods to destroy men by wholesale; and for their Industrious Tedious Assiduity may fitly be call’d, The Artistical Sons of Violence, and Masters of Art and Doctors for their Progress and Success, the greatest Physicians being but Novices and Children in the Arts of Healing, to what the other are in those of Destruction; but they go by Names of Gunners, Casters of Bombs, Grenadoes, Ingeniers and the like, for their skill in taking and desolating Cities, and raising Fortifications, Batteries and Bulwarks, and other Arts of War.
(T. Tryon, The Knowledge of a Man’s Self the Surest Guide to the True Worship of God, and Good Government of the Mind and Body, 2 vols., 1703–4, 2.136)
Tryon wrote the above passage towards the end of his life, and at the close of the 17th century — much of which England had spent embroiled in war. Tryon argued elsewhere in his “Book of Trade” that so much war had ruined the British economy, but it was unquestionably a boon to military science & technology, which saw many advancements. Tryon’s contemporary, John Aubrey (1626–1697), who had his own connection with the North American colony founded by William Penn, jotted down some notes of antiquarian interest on the subject in February 1680:
Gunnes. The Almanack chronologie tells us (1680) — “Since the invention of gunnes” — by ..., a monke of ..., in Germany — “270 yeares,” scil. in the reigne of [Henry IV], anno 1410. Philip de Commines tells us that in his time, when Charles 8 went into Italy, the country-people flocked mightily to see the great gunnes shott off, which was the first time they came in use: but musquetts and fowling-peeces came not to perfection long after. Memorandum:—in the Princes’ Chamber at the House of Lords, scil. the roome where the king does retire, are very old hangings, viz. of Edward the Fourth’s time, in which is described the invention and use of gunnes. The muskets there are only a long tube stop’t at one end, with a touch-hole, and fitted to a long staff. This gun one holds on a rest and aimes; and then another comes with a lighted match in a stick and gives fire, so that ’twas the worke of two men then to manage one piece. Till the late warres refined locksmiths’ worke, I remember when I was a boy
the firelocks were very bungling to what they now are. And in queen Elizabeth’s time they used calivers, of which I remember many in gentlemen’s halls before the civill wars (for then the soldiers converted them into carbines). The stock was like a wooden basting-ladle, and it had a match-lock, and was not much longer then a carbine.
“Cualibre” in French signifies the bore of a gun, or the size of the bore; and (thence) also the size capacity or fashion of any such thing—Cotgrave’s Dictionary.
(J. Aubrey, MS. note with drawing, first printed in Brief Lives, chiefly of Contemporaries, Set Down by John Aubrey, between the Years 1669 & 1696, ed. A. Clark, 2 vols., 1898, 2.320–21)
Like Tryon, Aubrey was war-weary, and dismayed by the increasing militarism of English culture. Tryon complained often in The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ... and elsewhere about the power of noisy drums to incite violence (especially in children):
Another thing, my Friends and Country men, which I desire you to consider, is, the innumerable Evils and cruel Miseries man draws upon himself, and the whole Creation, [in] the common use of war-like destructive murthering Weapons, and their Appurtenances, viz. Guns, Swords, Powder, Bullets, Shot, Drums, and the like Devilish Instruments; I may properly so call them, for no doubt the invention and use of them all did originally proceed from, and is still fomented by the fierce Wrath; for as they have been always used for Destruction, so indeed they can have no other use, but only to awaken and encourage Wrath and Blood-shed; Therefore let not our Streets (the Temples of Peace, and Tabernacles of Love and Innocence) be encumbred with such mischievous Tools; let not our pure Air be disturbed with their ungrateful Noises, Clashings, Ratlings and Bouncings, nor poluted with the Sulpherous Steams they send forth, as if so many Devils had marcht through the Skey, and left the stench of the Infernal Regions behind them.
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 17)
Tryon much preferred the natural music of the spheres, and especially the song of birds:
... the Harmonious Blackbirds, the sweet Quavering Thrushes, and the high soaring Lark (who every Morning sends up a Sacrifice of Melody in the Suburbs of Heaven, and whom all, not stupified into Brutality, are half ravisht to hear, such are their charming Notes) ....
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 50–1)
Nor was he alone in this preference. During the 17th century, it was not uncommon for the built environment — “adorned with fragrant and health-breathing Trees” (Henry Oldenburg, “An Accompt of Some Books,” Philosophical Transactions of the Royal Society of London, 1675, No. 114, p. 324) — to be designed for birds as well as humans. Country-style homes built for the wealthy often had surrounding gardens to attract the birds so that occupants would be serenaded morning and evening, as in the planned farming environments recommended by agrarian reformers associated with Samuel Hartlib, such as the agriculturalist Cressy Dymock (fl. 1629–1660), who described the ideal plantation as:
... here [see Dymock’s map, reproduced below] your house stands in the middle of all your little world ... enclosed with the Gardens and Orchards, refreshed with the beauty and odour of the blossomes, fruits and flowers, and the sweet melody of the chirping birds ... besides all other wayes of Improvement that may be farther added, this alone [i.e., “the most perfect right and ample Use of every foot of ground inclosed entire”] ... is enough to improve the value of your Estate one half part; viz. that if it were really worth 100 li. per annum before, it will thus become as really worth 150 li. per annum, and the charge in casting it into this forme, (especially where no fences are already) little more, in some cases not so much, though I must tell you, you cannot spare in any case more unhappily then here. And besides profit, the ease and pleasure will be better felt then exprest in words.
(Cressey Dymock, in A Discoverie for Division or Setting Out of Land, as to the Best Form, ed. by Samuel Hartlib, 1653, 10–11)
The “ungrateful Noises, Clashings, Ratlings and Bouncings” of “war-like destructive murthering Weapons, and their Appurtenances” were not an improvement on the melodies of nature as far as Thomas Tryon was concerned, and, as he argued in The Planter’s Speech, such a violent assault on the senses exacted a psychic toll. Aubrey also remarked on this, confirming Tryon’s complaints about the rising levels of martial-style noise with a note (again, written in February 1680) documenting historic changes in festival music:
Tabor and pipe. When I was a boy, before the late civill warres, the tabor and pipe were commonly used, especially Sundays and Holydayes, and at Christnings and Feasts, in the Marches of Wales, Hereford, Glocestershire, and in all Wales. Now it is almost lost: the drumme and trumpet have putte that peaceable musique to silence. I believe ’tis derived from the Greek sistrum, a brasen or iron timbrel; cratalum [i.e., crotalum], a ring of brasse struck with an iron rod—so we play with the key and tongs.
(J. Aubrey, MS. note printed in Brief Lives, chiefly of Contemporaries, Set Down by John Aubrey, between the Years 1669 & 1696, ed. A. Clark, 2 vols., 1898, 2.319)
So even in the 1680s, a number of health issues (noise pollution and air pollution being just two of them) were associated with the introduction of guns — a foreign technology — to North America:
And we are more especially astonish’t to meet with these usages from those that call themselves Christians, who of late years have found out and settled themselves in the Regions and Countries of America, where before their Arrival we lived in a very great degree of freedom and security. But now by this new Neighbour-hood of those from whose, Profession we might promise our selves nothing but Love and good Will, our Condition is much altered for the worse, our Danger and Destruction is daily encreased, and to kill and murder us is become an Occupation and a Trade, for which purpose these peaceable Christians (as they would be counted) have brought with them all kinds of Snares and Engines of War and Violence, which never had before been seen, nor their frightful hellish Noises heard in our Coasts. Now how absurd is it for those who fly from Violence in one place, to begin it themselves on the Innocent in those places where they take shelter?
(T. Tryon, The Planter’s Speech to his Neighbours & Country-Men of Pennsylvania, East & West-Jersey ..., 1684, 43-4)
Today, critics complain that President Obama and his nominee for surgeon general, Dr. Vivek Hallegere Murthy, have politicized the office of public health, even though “the medical care of Americans” has traditionally been intertwined with guns, god, and government — at least since the founding of Pennsylvania in 1681.
Unlike our shrill debates today, Thomas Tryon’s late-17th-century discussion of the issues surrounding health care in the British Americas was suitably wide-ranging and visionary. For Tryon and his contemporaries, the health and well-being of all Americans (not just of the human variety, but also the land animals, birds and fish of North America) was inextricably tied to related issues of trade & finance, globalization, protectionism, taxes, economic growth, sustainability, government-mandated “austerity” programs, poverty, rising inequality, job loss, immigration policy, cultivating the arts & sciences, education, food security (food prices and subsidies), social engineering, “well-doing” (public-service work), and good government (of public, private, and personal domains).
Read his argument and judge for yourself.
Whether you agree or disagree (and I find myself doing both), Tryon’s brand of Christian humanism will challenge you to think in deep, traditional ways about the age-old question of what it means to be an American.
NOTE: I have another, related original Roses digital edition to announce: George Keith’s An Exhortation & Caution to Friends Concerning Buying or Keeping of Negroes (New York, 1693). This 6-page tract was the first protest against slavery printed in America, and it was influenced by Tryon and his much earlier Friendly Advice to the Gentlemen-Planters of the East and West Indies in Three Parts (London, 1684). I plan to do a digital edition of Tryon’s Friendly Advice at some point in the future. In the meantime, you can find quotes from this interesting text, and a bit of introduction to it, in the second-window aside re. Thomas Tryon’s A Dialogue between an East-Indian Brackmanny or Heathen-Philosopher, and a French Gentleman concerning the Present Affairs of Europe (London, 1683).
Next up: an original Roses digital edition of another of Thomas Tryon’s texts — his “Book of Trade,” full of original remarks on the evolving business of life & death in the 17th century.
[ UPDATE: posted on 2/13/2016;
revised 6/30/2016, 8/7/2016, 12/14/2016 and 1/5/2017 ]
A superb investigative report by Jeanette Steele on “The Fight Against Veteran Suicides” published in the San Diego Union-Tribune for 7 February 2016 reminds us that gun-related domestic violence in the U.S. is not limited by gender, race, ethnicity, age, or community.
As always, Steele’s take on complex military matters is layered and nuanced, and this latest report from her deserves to be read in its entirety; a few excerpts can not do it justice. Nonetheless, I would like to take this opportunity to note that
San Diego provides a rare window on post-9/11 veterans and the issue of suicide, perhaps one not available anywhere else in the nation.
With nearly 28,000 of these former service members, the county is the nation’s largest hub of Iraq and Afghanistan war-era veterans.
(J. Steele, “The Fight Against Veteran Suicides,” A1)
and to reiterate the difficulties of finding simple nation-wide solutions:
Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America, compared today’s situation regarding veteran suicides to the early days of the AIDS crisis.
“I feel like we are losing our friends left and right and no one is paying attention,” Rieckhoff said.
“People thought AIDS was a gay problem. People think vets dying by suicide is a government problem,” he said. “Until we address it as a public health challenge, we’re going to be nibbling around the edges.”
Rieckhoff said the 27 veterans’ stories [profiled by Steele] are troubling because San Diego is known nationally as a region with deep resources for veterans.
“If it’s this bad in San Diego, imagine what it’s like in other places,” he said.
(J. Steele, “The Fight Against Veteran Suicides,” A19)
Steele’s investigation suggests that “easy access to guns” is an important — but by no means the only — factor in the “perfect storm” that is fueling our suicide problem:
The VA offers free gun trigger locks to veterans, often as a follow-up for those who call its national crisis hotline.
Another idea is to convince them to separate their ammunition from their weapons, or to agree to store weapons away from home.
The point is to slow someone down if they want to pull the trigger.
Millard of Swords to Plowshares said the idea of removing guns entirely is a taboo subject in the veterans community.
“No one wants to take it on,” he said. However, the Army infantry veteran added that he’s not a gun owner — and not because he is anti-gun.
“I don’t own a gun because I know the statistics behind veteran suicide, and I have PTSD. I know I wouldn’t be having this phone conversation.”
(J. Steele, “The Fight Against Veteran Suicides,” A20)
Her series in the print edition of the newspaper was divided into 5 parts:
“The Fight Against Veteran Suicides: What might have saved these vets? The families of young veterans in San Diego share similar stories about the toll of isolation, PTSD, guns, alcohol abuse and easy access to pills,” by Jeanette Steele (San Diego Union-Tribune, 7 February 2016, pp. A1 and A19–A20).
“Medications Remain the Go-To Treatment for PTSD,” by Jeanette Steele (San Diego Union-Tribune, 7 February 2016, p. A21).
“Keeping an Eye on High-Risk Vets,” by Jeanette Steele (San Diego Union-Tribune, 7 February 2016, p. A21).
“What Might Have Saved these Vets? Special Project: Profiles of Young San Diego County Veterans who Died by Suicide,” by Jeanette Steele (San Diego Union-Tribune, 7 February 2016, pp. SD1–SD5).
NOTE: In the print edition, this began the 27 veteran profiles. The online edition has been organized differently. To access the 27 profiles, you need to return to the Special Report: Veterans and Suicide page, and use the graphic link at the top of the page for each veteran’s story.
“A Health Problem with Solutions,” by Jeanette Steele (San Diego Union-Tribune, 7 February 2016, p. SD1).
Although not part of Steele’s 7 February 2016 series, there are closely related stories
“According to Report, VA’s Suicide Hotline Has Major Woes: Calls went to voicemail, then were not returned in timely manner or at all,” by Matthew Daly (San Diego Union-Tribune, 21 February 2016, p. A28).
“VA Addresses Suicide by Gun Problem among Female Veterans,” by Emily Wax-Thibodeaux (posted to The Washington Post website on 8 October 2015).
“Female veterans who try to take their own lives are often successful at a far higher rate than their female non-veteran counterparts because of one reason: They use guns.”
and I would like to supplement these with a few more links, of the many I’ve been accumulating, to news reports relating specifically to women warriors:
Op-ed, “Military Women Let their Service Speak for Itself,” by U.S. Marine Corps lieutenant colonel (ret.) Kate Germano (San Diego Union-Tribune, 7 August 2016, pp. SD4 and SD6), retitled “Women Overcome Barriers for Greater Role in Military” for online posting.
“Unfortunately, once they leave the service, many female veterans report that their service is not valued or respected by the public. If they show their identification cards or wear clothing with military logos, people assume that they are simply spouses or girlfriends of servicemen. These women are indeed wives, daughters, mothers and sisters. But they are also military leaders, warriors, academics and mentors in their own right.” (K. Germano, SD6)
“Why Homecoming Can Be Particularly Hard for Female Veterans,” Gayle Tzemach Lemmon’s report for the PBS NewsHour (originally aired: 4 March 2015).
SUMMARY: “In the return to civilian life, many women find that veteran services fall short of their needs. Unemployment rates for female veterans are higher than for other women, as well as for male veterans. Female veterans are at least twice as likely to be homeless than women who haven’t worn a uniform. Special correspondent Gayle Tzemach Lemmon reports on the challenges they face.”
see above, under entry dated 11/24/2014 for more reporting specific to American women warriors of color.
Gretel C. Kovach’s ongoing reporting on women in the military, accessible from the special section on “Women in Combat” at the website for the San Diego Union-Tribune.
“These Women Aspire to Combat Roles — Now They’re Training for Them,” Part 1 of 2 in William Brangham’s 2-part series for the PBS NewsHour (originally aired: 8 December 2016).
SUMMARY: “Until recently, women were barred from U.S. military combat jobs. Today females are volunteering for the most physically and mentally grueling Marine roles. But is the Corps helping or hurting women recruits’ readiness by separating training from males? In a two-part series, William Brangham follows three female Marine recruits as they embark on tougher training than they have ever undergone.”
“Female Marine Recruits at Boot Camp Strive to Meet the Same Standards as Men,” Part 2 of 2 in William Brangham’s 2-part series for the PBS NewsHour (originally aired: 9 December 2016).
SUMMARY: “For generations combat jobs in the U.S. military were blocked to women, but not anymore. The question now is can women meet the same rigorous standards as the men in order to qualify for frontline jobs? William Brangham has the second story on women in combat roles.”
Op-ed dialogue, “A Woman’s Duty? Pro and Con” (San Diego Union-Tribune, 21 February 2016, pp. SD4 and SD6).
SUMMARY: “Military leaders sparked a national debate this month when they said women should be required to register for future military drafts. A 1981 Supreme Court decision to uphold exempting women from the draft was based on combat restrictions. Now that women are allowed to serve in all combat roles, some say that equality should extend to the draft and registering for Selective Service, just as all U.S. males are required to do on their 18th birthday. Others believe that while qualified women should be able to volunteer, they should not have to register for the draft. Here are two views on the issue.”
1. Op-ed FOR women registering for the draft: “Why Women Should Be Drafted” by Marissa Loya (pp. SD4 and SD6).
2. Op-ed AGAINST women registering for the draft: “Why Women Should Not Be Drafted” by J. F. Kelly Jr. (pp. SD4 and SD6).
“The Wrong Question about our Military: Candidates weigh in on whether women should register for the draft, but neglect the real issues,” by Andrew J. Bacevich (Los Angeles Times, 14 February 2016, p. A29), retitled “Op-Ed: Should Women Register for the Draft? That’s the wrong question to ask about our military” for online posting.
“Pentagon Orders Combat Jobs Open to Women” retitled “All Combat Jobs Will Open to Women: Despite request from Marines, defense secretary says, ‘There will be no exceptions.’” for online posting, by Jeanette Steele (San Diego Union-Tribune, 4 December 2015, pp. A1 and A8).
“[Defense Secretary Ashton] Carter acknowledged that the Marine Corps commandant asked for exceptions for roles including infantry, machine gunner and reconnaissance — the only service to do this. ¶ A multiyear Marine Corps study determined that women were injured more often while attempting combat jobs. Also, fighting teams that included women were less effective than all-male teams. ¶ Carter said he considered the arguments of the Marine Corps, but, ‘I came to a different conclusion.... I believe that we could in implementation address the issues that were raised,’ though he didn’t elaborate about how. ¶ ‘There will be no exceptions. This means that as long as they qualify and meet the standards, women will now be able to contribute to our mission in ways they could not before,’ Carter said.” (J. Steele, A1 and A8)
Op-ed dialogue, “Women in Combat: Pro and Con” (San Diego Union-Tribune, 18 October 2015, pp. SD4 and SD6).
SUMMARY: “As the deadline nears for integrating women fully into the U.S. armed forces, the battle over mixed gender combat units has intensified. Here, two local veterans — John E. Hein and Marissa Loya — share their views on the issue.” (SD4)
1. Op-ed FOR women in combat: “Qualified Females Capable of Serving” by Marissa Loya (pp. SD4 and SD6).
2. Op-ed AGAINST women in combat: “Needs of the Military Must Come First” by John E. Hein (pp. SD4 and SD6).
“Veteran of Marine Gender Fight Speaks Out: Officer once on the rise undercut during pursuit for equality in combat roles” retitled “Why Marines Have a Problem with Women in Combat: Lt. Col. Kate Germano, exiled former commander of the Corps’ female recruit battalion at Parris Island, makes the case for change” for online posting, by Gretel C. Kovach (San Diego Union-Tribune, 20 September 2015, pp. A1 and A17).
“Before [Lt. Col. Kate Germano] was fired for what the Corps described as toxic leadership, abuse of authority and poor ‘playground skills,’ Germano had lobbied for the dismantling of the service’s current system of gender-segregated boot camp instruction. ¶ She thinks the Corps should reinstate its old methods that had men and women shoulder-to-shoulder during basic training, tackling the hikes, obstacle courses and classroom lectures together, as recruits do today in all of the nation’s other military services.” (G. C. Kovach, A1)
“As much as Germano loves the Corps and its values of honor, courage and commitment that she devoted nearly 20 years to, she said the Marines are getting left behind by their fraternalism. ¶ ‘This whole hyper-masculine culture is a weakness,’ she said. ‘You want to know why we have such a problem with sexual assault? It is because there is a fundamental respect lacking between male and female.’” (G. C. Kovach, A17)
“Will the First Women to Finish Ranger School Change What’s Off Limits in the Military?,” Judy Woodruff’s interview with Gayle Tzemach Lemmon and Col. Ellen Haring for the PBS NewsHour (originally aired: 18 August 2015).
SUMMARY: “For the first time, two women have completed the Army’s rigorous Ranger School training program. But unlike their fellow male graduates, they will not yet be allowed to serve in elite Ranger units, due to the Pentagon’s current ban on women in combat. Judy Woodruff talks to Gayle Tzemach Lemmon of the Council on Foreign Relations and retired Col. Ellen Haring of Women in International Security.”
“The Sister Soldiers Who Assisted Special Ops in Afghanistan,” Margaret Warner’s interview with Gayle Tzemach Lemmon for the PBS NewsHour (originally aired: 22 April 2015).
SUMMARY: “In Afghanistan, an elite band of female U.S. soldiers were deployed on risky night raids with one of the toughest special operations units. Margaret Warner talks to Gayle Tzemach Lemmon, who recounts their story in her book, Ashley’s War.”
“Why Some Americans Are Volunteering to Fight the Islamic State,” Marcia Biggs’s report for the PBS NewsHour (originally aired: 21 July 2015).
SUMMARY: “The State Department estimates that more than 150 Americans, including some U.S. military veterans, have packed their bags and flown to Iraq and Syria to volunteer with forces fighting against the Islamic State militant group. Special correspondent Marcia Biggs reports on what’s driving these soldiers.”
Among the volunteers interviewed by Biggs: Samantha Johnston, who “faces a firestorm of controversy over leaving behind her 5-year-old and her 3-year-old twins to volunteer in a war on the other side of the world, where we’re told I.S. fighters have put a $300,000 price on her head.”
A brief discussion of veteran suicide rates, linked to transitioning from a military life to a civilian life (“an overwhelming paradigm shift that some folks can’t handle well, and some can’t handle at all”), can be found in the comments section, directly following the transcript.
“How Kurdish Women Soldiers Are Confronting ISIS on the Front Lines,” Martin Himel’s report for the PBS NewsHour (originally aired: 3 May 2015).
SUMMARY: “In Iraq, an all-female unit within the Kurdistan Workers’ Party, or PKK, is on the front lines of a fierce battle against the Islamic State. Martin Himel reports.”
“Crackdown in Turkey Threatens a Haven of Gender Equality Built by Kurds,” by Rod Nordland (posted to the New York Times website, 7 December 2016).
Describes the Kurd tradition of gender equality as owing in great part to the prominence and social status of Kurdish women soldiers.
“Kurdish guerrilla units are fully integrated by gender: Women occupy the same combat roles as men, and when the military goes to war, it sends a woman to command one of its major units.” (R. Nordland, n. pag.)
“Arzu Demir, who has written two books about the Kurdish female guerrillas, says that the female role in Kurdish military units was a major factor in their growing assertion of equal rights generally. ¶ ‘Their strength comes from being organized, and because they are armed,’ she said. ‘There are always men thinking that women are slaves, but when women are an armed force, men are scared of them.’” (R. Nordland, n. pag.)
But Kurdish women’s rights in many heavily Kurdish areas of eastern Turkey are now under siege. “There is one big problem with this aspect of Kurdish life, in Turkey at least: It has, in effect, been outlawed as part of the Turkish government’s crackdown after a failed coup attempt last summer. Along with arresting Kurdish political leaders, the government is taking aim at measures meant to promote gender equality.” (R. Nordland, n. pag.)
Op-ed, “The Real Amazons” retitled “Where Wonder Woman Came From” for online posting, by Adrienne Mayor (Los Angeles Times, 30 November 2014, p. A29).
Adrienne Mayor, author of The Amazons: Lives and Legends of Warrior Women across the Ancient World, provides here a synopsis of new scholarship with “compelling evidence that in the 7th century BC, Greek colonists and traders encountered astonishingly independent warrior women, members of diverse but culturally related nomadic tribes that were distinguished by gender equality and that ranged across the steppes of Eurasia from 700 BC to AD 300.” (A. Mayor, A29)
“Like the ancient Greeks, Americans today are fascinated by heroic superwomen: Katniss Everdeen of ‘The Hunger Games’ strides at the head of long line of female heroes from Wonder Woman to Marvel Comic’s brand-new hammer-throwing female Thor. And like the Scythians, Americans today see egalitarianism — extending even to women in combat — as a matter of common sense. ¶ And yet, in too many places women remain violently oppressed. And even in some of the most forward-thinking nations, the battle for equality remains incomplete. Thousands of years after the Greeks and Scythians — and despite our heroic female idols and civil rights — we have yet to fully achieve what the mythic and historical Amazons portend: a world in which women are truly the equals of men in every domain.” (A. Mayor, A29)
POSTED 2/11/2014 — As of February 2014, I have temporarily stopped maintaining the lists of annotated links on Roses Web pages, such as the media links section of our FYI page entitled “Conversations About a Wiser Use of Our Health Care Dollars & Resources.”
It takes a lot of time to update these lists, and the task has become even more onerous since the PBS NewsHour redesigned their website the beginning of this month, rendering all of our deep links to content posted at the NewsHour website before the redesign invalid. In short, every one of our links to PBS NewsHour content now returns a “Page not found” error.
It will be tedious and costly for me to update all of our NewsHour links, and since the search engines already penalize us for “deep linking” in the first place (e.g., none of the Big 3 search engines in the U.S. will index any of the content on our “Conversations About a Wiser Use of Our Health Care Dollars & Resources” page), I’ve decided to shift priorities and attend to other matters for a while.
For the next few months, I will be finishing up an original webessay on 17th-century “political arithmetic” relating to corporate- and government-funded health care in an earlier age of globalization and merchant capitalism: at the founding of the United States in the early decades of the 17th century. (Teaser for what’s to come: the first hospital in English America was established in 1611.) The scholarly monograph will be supplemented by several digital editions of related texts by 17th-century authors, and will be heavily illustrated, including digital facsimiles of 4 antique maps.
Once this new content is finished and posted to Roses, I will get busy on our next big project: spinning off a new Web page on “Wise Use of Medical Technology & Automation” from the present “Conversations About a Wiser Use of Our Health Care Dollars & Resources” page. Moving affected links around from one Roses Web page to another is a major restructuring effort, and probably the best time to update all NewsHour URLs, and to resume deep linking to other media stories about health care costs and health care reform.
[ UPDATE posted on 2/26/2014 ]
I’ve been resisting the urge to add any new media links before I’m able to update all of the erroneous links now at Roses, but today I made an exception for 2 stories which aired on American Public Media’s radio program, Marketplace, on 25 February 2014.
Marketplace’s reporting on Connecticut’s new health-care consulting business, branded “Health Exchange-in-a-Box,” caught my ear, because of its historical resonance.
Connecticut has been a health-care pioneer since the mid-seventeenth century, when it became the center for alchemical medical practice (iatrochemistry) in the colonial Americas, as advanced by the social reformer and physician, John Winthrop the younger (1606–1676).
Winthrop’s visionary New London plantation, settled in 1646, was “a hospital town, to which patients travelled from all over New England, and from which Winthrop distributed medications and advice to places as far away as the Caribbean and Europe.” And as governor of Connecticut from 1657, Winthrop “established a travelling medical clinic that is estimated to have served up to half of Connecticut’s population.”
I shall be referring to Winthrop’s alternative institutional model in my forthcoming webessay on 17th-century corporate- and government-funded health care practices (and will give references for quotes then).
In the meantime, here’s some more historical context for Connecticut’s recent health-care reform initiative: John Winthrop Jr. was active in “the pansophic reform movement of Jan Comenius and the circle associated with Samuel Hartlib,” as well as the first colonial member of The Royal Society of London for the Improving of Natural Knowledge, in which capacity Winthrop conducted “sounding trials” and other “sea experiments” for the Royal Society in the early 1660s, using oceanographic research equipment designed by Robert Hooke.
Winthrop was a fascinating figure, bringing European debates about science and technology from the old world to the new, and along with the American-born alchemist, George Starkey (1628–1665) — one of Isaac Newton’s favorite authors — bringing the realities of the new world to bear on the verities of the old. In such manner, an early governor of Connecticut was integral to the transformation that European English culture underwent in the New World.
POSTED 12/5/2013 — I’m happy to announce that the first digital edition in our series of texts relating to the history of medical science has now been posted to the Roses website:
Two excerpts from the 1979 “interpretive translation” of Ludwik Fleck’s German-language publication, Entstehung und Entwicklung einer wissenschaftlichen Tatsache. Einführung in die Lehre vom Denkstil und Denkkollektiv (Basel: Benno Schwabe, 1935), Englished as Genesis and Development of a Scientific Fact (edited by Thaddeus J. Trenn and Robert K. Merton, translated by Frederick Bradley and Thaddeus J. Trenn, with a foreword by Thomas S. Kuhn; Chicago: University of Chicago Press, 1979).
As some of you know, I hadn’t planned to lead the series with Fleck’s work. But the decision was basically made for me when I decided to post a link to Michael Hiltzik’s 10/27/2013 column for the Los Angeles Times, “Science Has Lost Its Way, Costing All of Us”:
see the annotated entry for 27 October 2013 in the media links section of our FYI page entitled “Conversations About a Wiser Use of Our Health Care Dollars & Resources.”
As I comment there, the Polish medical microbiologist Ludwik Fleck (1896–1961) wrote on epistemological questions — what is an empirical fact? how does it originate? and in what does it consist? — which are central to our modern age. His monograph of 1935 pushed the historical sociology of science to a new level, and is now recognized as
A work of transparent brilliance: one of the most significant contributions toward a thoroughly sociological account of scientific knowledge.
(Steven Shapin, in the journal Science; qtd. on the back cover of the paperback edn. of Genesis and Development of a Scientific Fact, Chicago, 1981)
In his monograph, Fleck stated
I believe that the concept of syphilis is unattainable except through a study of its history.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 21)
then proceeded with an extensive case study of the historical development of the scientific concept of syphilis — “an extremely pleomorphic disease of many aspects” (Fleck, 1979, 12) — and of the first diagnostic proof procedure for syphilis, known as the “Wasserman reaction,” which exemplified
The problem of how a “true” finding can arise from false assumptions, from vague first experiments, and from many errors and detours.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 78)
thus proving that
All empirical discovery can therefore be construed as a supplement, development, or transformation of the thought style.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 92)
“Furthermore,” argued Fleck,
whether we like it or not, we can never sever our links with the past, complete with all its errors. It survives in accepted concepts, in the presentation of problems, in the syllabus of formal education, in everyday life, as well as in language and institutions. Concepts are not spontaneously created but are determined by their “ancestors.” That which has occurred in the past is a greater cause of insecurity — rather, it only becomes a cause of insecurity — when our ties with it remain unconscious and unknown.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 20)
This is a fitting introduction for our new history section, as is Fleck’s argument
If we want to investigate an earlier thought style, we must examine the original sources, not modern summaries of old viewpoints.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 126)
I hope to make many “old viewpoints” live again as original Roses digital editions, for this very reason.
There is a great deal in Fleck’s rich body of work which is beyond the scope of my present study. But there is one other idea of Fleck’s I wish to highlight here, because it implicitly critiques the “war on cancer” framework which has directed so much research in recent years. In the process of explaining the concept of infectious disease, Fleck suggested — in 1934 — that disease is better understood and styled as a “revolution” than an “invasion”:
The concept of infectious disease. This is based on the notion of the organism as a closed unit and of the hostile causative agents invading it. The causative agent produces a bad effect (attack). The organism responds with a reaction (defense). This results in a conflict, which is taken to be the essence of disease. The whole of immunology is permeated with such primitive images of war. The idea originated in the myth of disease-causing demons that attack man. Such evil spirits became the causative agent; and the idea of ensuing conflict, culminating in a victory construed as the defeat of that “cause” of disease, is still taught today.
But not a single experimental proof exists that could force an unbiased observer to adopt such an idea. It is unfortunately beyond the scope of our discussion to examine all the phenomena of bacteriology and epidemiology one by one to show that the disease demon haunted the birth of modern concepts of infection and forced itself upon research workers irrespective of all rational considerations. It must suffice here to mention the objections to this idea.
An organism can no longer be construed as a self-contained, independent unit with fixed boundaries, as it was still considered according to the theory of materialism. That concept became much more abstract and fictitious, and its particular meaning depended upon the purpose of the investigation. For the morphologist it has changed into the concept of genotype as the abstract and fictitious result of hereditary factors. In physiology we find the concept of “harmonious life unit,” according to Gradmann, “characterized by the notion that the activities of the parts are mutually complementary, mutually dependent upon each other, and form a viable whole through their cooperation.” Morphological organisms of the type which are self-contained units do not have this ability. But a lichen, for instance, whose constituents are of completely different origins, one part an alga, another a fungus, constitutes such a harmonious life unit. The constituents are closely interdependent and on their own are usually not viable. All symbioses, for instance, between nitrogen-fixing bacteria and beans, between mycorrhiza and certain forest trees, between animals and photogenic bacteria, and between some wood beetles and fungi form “harmonious life units,” as do animal communities such as the ant colony, and ecological units such as a forest. A whole scale of complexes exists which, depending upon the purpose of the investigation, are regarded as biological individuals. For some investigations the cell is considered the individual, for others it is the syncytium, for still others a symbiosis, or, lastly, even an ecological complex. “It is therefore a prejudice to stress the idea of organism,” in the old sense of the word, “as a special kind of life unit, a prejudice which is unbecoming to modern biology” [Gradmann, 1930, 666]. In the light of this concept, man appears as a complex to whose harmonious well-being many bacteria, for instance, are absolutely essential. Intestinal flora are needed for metabolism, and many kinds of bacteria living in mucous membranes are required for the normal functioning of these membranes. Some species exhibit for their vital functions an even greater dependence upon others. Their metabolism and propagation, indeed their entire life cycle, depend on a harmonious interference by other species. Some plants are pollinated by certain beetles; and malarial plasmodia depend for their life cycle upon their transmission by mosquito to man.
Now continuous biological changes, within any complex biological individual, so construed are based upon phenomena which can be divided into several categories. They constitute either (1) a kind of spontaneous so-called constitutional process within the genotypes, such as mutations and spontaneous gene changes, roughly comparable with spontaneous radioactive phenomena within an atom. Many a disease belongs to this category, such as the hemolytic icterus of Nägeli, and even the outbreak of certain epidemics might perhaps be included here. Or they are (2) cyclic changes, of which some are genotypically conditioned and others are the result of reciprocal action within the complex life unit. These include the life cycle of organisms (aging), generational change, and some of the dissociation phenomena of bacteria. Both serogenesis and immunogenesis must be listed here, as well as virulence as a life phase of bacteria and even some infectious diseases, such as furunculosis during puberty. Or, lastly, they are (3) pure changes within the constellation of reciprocally acting parts of the unit comparable, for instance, to the reaction among ions in a solution. Hypertrophy of one element of the biological unit at the expense of another is a change of this type, as is the imbalance either consequent upon phenomena of the first or second category, or caused by external physico-chemical conditions. Most infectious diseases belong to this latter class. It is very doubtful whether an invasion in the old sense is possible, involving as it does an interference by completely foreign organisms in natural conditions. A completely foreign organism could find no receptors capable of reaction and thus could not generate a biological process. It is therefore better to speak of a complicated revolution within the complex life unit than of an invasion of it.
This idea is not yet clear, for it belongs to future rather than present biology. It is found in present-day biology only by implication, and has yet to be sorted out in detail.
So construed, the concepts “sickness” and “health” also become unsuitable for any exact application. What used to be called infectious disease or the spread of epidemics belongs partly to the first, partly to the second or even the third group of phenomena. Biologically, this also includes phenomena such as germ carrying, latent infection, the development of allergies, and even serogenesis. These have nothing directly in common with being ill, although they are very important to the mechanism of the disease. The old concept of disease thus becomes quite incommensurable with the new concepts and is not replaced by a completely adequate substitute.
(Fleck, Genesis and Development of a Scientific Fact, 1979, 59–62)
POSTED 10/5/2013 — With open enrollment in the new health insurance marketplace (legislated by the Affordable Care Act, also known as Obamacare) beginning on 1 October 2013, I am gearing up for all the new content I expect to be adding to the media links section of our FYI page entitled “Conversations About a Wiser Use of Our Health Care Dollars & Resources.”
That section is already getting quite long, and to help manage its content better, I have today added a highlighter function — tagging a particular pointer as a “Featured Link” — whereby I can single out particular media reports for special attention.
Our first featured link is to
The Women’s Health Activist newsletter article by Cynthia Pearson, “Health Care Coverage: It’s Finally Happening!,” from the September/October 2013 print issue, vol. 38, no. 5, pp. 1, 3 and 5.
Pearson is Executive Director of the independent National Women’s Health Network (NWHN). Their mission:
The National Women’s Health Network improves the health of all women by developing and promoting a critical analysis of health issues to influence public policy and support consumer decision-making. The Network aspires to a health care system that is guided by social justice and reflects the needs of diverse women.
NWHN has spent years on the front lines fighting for health care reform, and is now working “to ensure that women know how they and the people they care about can get good coverage through the new health insurance Marketplaces.” (Pearson, 1)
In her article for the September/October 2013 issue of The Women’s Health Activist, Pearson counsels all women:
You may feel like it’s not worth your trouble to enroll, particularly if you are young and/or healthy. For those on a budget, even the least expensive plans may seem unaffordable at around $200 per month. In 2014 people who don’t sign up for coverage will pay a $95 penalty at tax time. But, you’re really shortchanging yourself if you pay the penalty instead of paying for insurance. Bad things can happen unexpectedly, making insurance very important. So sign up and, if you already have coverage, encourage others to enroll as well. Women are often the decision-makers when it comes to a family’s health care decisions — we should use our influence to protect the ones we care about and make sure they get the coverage they need. Use your power! Make sure your boyfriend, son, cousin, and other family members know that getting health insurance is important.
(Pearson, 3 and 5)
NWHN offers “helpful fact sheets about what women get from health reform, and clear explanations of how the Health Marketplaces will work” at Raising Women’s Voices (RWV), which is
a national initiative working to make sure women’s voices are heard and women’s concerns are addressed as policymakers put the health care law into action. We believe women are grassroots experts in what is wrong with the current health system and what it takes to fix it because of our roles as arrangers of health care for our families.
(home page, RWV website)
Check it out. There’s a lot of solid information here, geared at helping women and their loved ones learn how Obamacare “affects you and what you can do to make sure that the promise of the health care law [becomes] a reality for women!”
[ UPDATE: another link added on 11/4/2013 ]
Hari Sreenivasan’s interview with Kathleen Gerson for PBS NewsHour Weekend, aired 2 November 2013: “Where Do American Women Stand in Gender Equality?”
SUMMARY: “The World Economic Forum published a report recently that says the United States finishes far from the top of a list when it comes to gender equality. American women finished 23rd on the list of 136 countries. Kathleen Gerson, a Sociology professor at New York University sheds light on the findings.”
Among other findings, Sreenivasan notes that U.S. women rank 53rd “when it comes to the specific measure of healthy life expectancy ... And that’s much lower than one would think living in the US.”
Gerson responds: “It’s very counterintuitive since we talk all the time about our high life expectancies especially for women. But I think that that the lesson here is we are quite obviously one of the few, the only industrial wealthy country in the world that doesn’t have a national health system, and I think that is showing up in these statistics. That we like to think of ourselves as being one of the healthiest countries on earth but in fact when you put it all together, people at the top may be doing well but we’re not as a country doing that well compared to other societies.”
[ UPDATE: posted on 1/7/2016; revised 8/7/2016 ]
NWHN’s Raising Women’s Voices (RWV) health-literacy campaign continues its push
... to help newly-insured women use their health coverage to get the care they need, while avoiding unexpected costs. The centerpiece of this campaign is a new resource, My Health, My Voice: A Woman’s Step-by-Step Guide to Using Health Insurance. The guide was developed to address the specific problems newly-insured women are having using their health insurance, as identified by RWV regional volunteers.... Thanks to the generosity of a long-standing Network member, the guide will be produced in Spanish. We hope to release the Spanish-language version of the guide in early 2016.
(Cynthia Pearson, NWHN end-of-year fund-raising letter, 17 December 2015, n. pag.)
The new RWV companion website — devoted to “helping newly insured women get the most out of their health plans” — is an excellent resource, not just for women currently navigating Open Enrollment (in effect through 31 January 2016), but for all of us who “don’t like surprises when it comes to money.” A series of illustrated fact sheets — such as the one I have before me entitled “The 4 Kinds of Costs You May Pay” (Premium, Deductible, Co-pay, Co-insurance) — explain the process so that each of us can plan ahead, manage our costs, and make our own trade-offs about what we can and can not afford before we go to the doctor.
And there is good news to be had here, as well. Not all of your health care will cost you more money.
Preventive care is free to you with your health insurance. You can see a list of free preventive services at MyHealthMyVoice.com.
(“The 4 Kinds of Costs You May Pay” fact sheet, Copyright © 2015 Raising Women’s Voices)
But beware the extra charges for co-pays and tests that may be added on to “free” medical services.
“Does Affordable Care Act Cover Annual Physical?” by columnist David Lazarus (Los Angeles Times, 7 August 2016, p. C2), retitled “Obamacare Covers Free Annual Physicals, Right? Wrong” for online posting.
“Bailey’s wife, Peggy, 75, was billed $200 by her doctor for a mammogram. But when she pointed out that mammograms are a covered preventive service, the charge was removed. Nevertheless, she too had to cough up a $15 co-pay because her doctor went beyond the parameters of a free wellness visit for seniors by renewing a prescription.” (D. Lazarus, C2)
POSTED 9/13/2013 — Thanks to the PBS NewsHour for alerting all of us to a new report on the looming crisis in cancer care for U.S. citizens:
Americans are facing a growing crisis in cancer care. That warning, issued today by the Institute of Medicine, found demand is growing just as the workforce of cancer specialists is shrinking. At the same time, costs continue to rise. The report called for patients to get more involved in picking their care and their care givers.
(PBS NewsHour program for 9/10/2013, “Other News of the Day” summary, at about the 5:03 minute mark)
The Institute of Medicine report cited by the NewsHour’s Gwen Ifill is available here:
“Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis,” issued 10 September 2013 by the Institute of Medicine
with an abstract that reads:
In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. By 2022, it is projected that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. However, more than a decade after the IOM first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Therefore, the IOM convened a committee of experts to examine the quality of cancer care in the United States and formulate recommendations for improvement. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents the committee’s findings and recommendations.
The committee concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care. All stakeholders — including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industries — must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. Working toward the recommendations outlined in this report, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.
I interpret all this as yet more evidence of the need for innovative medical communications projects such as Roses, which promise improved access — for all of us, regardless of physical location — to the specialist know-how & expertise of the world-class gynecologic oncologists who treated (and continue to care for) me.
POSTED 8/16/2013 — As the push for genetic analysis of cancers continues, longstanding ethical concerns about how we handle tissue samples and share sensitive information derived from sequencing related genomes are finally getting some attention.
“Henrietta Lacks’ ‘Immortal’ Impact on Research Now Extends to Patient Consent,” a PBS NewsHour analysis of the issues (originally aired: 8 August 2013)
SUMMARY: “Henrietta Lacks died 62 years ago, but her cells — known as HeLa — live on through scientific research, having led to world-changing medical advances for decades. Margaret Warner talks to Dr. Francis Collins of the National Institutes of Health about a new agreement made with the Lacks family over control of her DNA legacy.”
The Obama administration is working hard on a new way to approach this so that that [the consent procedure] is not so ambiguous, so that science can flourish, but people have the opportunity to be participants, and not just subjects.
(Dr. Francis Collins, PBS NewsHour interview, 8/8/2013)
This will have important consequences for cancer patients who are thinking about becoming information donors (e.g., see entries for 30 June 2013 and 24 September 2012 in the media links section of our FYI page entitled “Conversations About a Wiser Use of Our Health Care Dollars & Resources”).
In addition to ethical issues and privacy concerns, the new policies which are being formulated raise financial questions, as was pointed out by two of those who posted responses to the PBS NewsHour interview.
While the Lacks family is a special case — because Henrietta Lacks never gave anyone permission to reproduce her cells for science and profit — those of us who willingly consent to be information donors face vexing questions about who can and/or should profit off our DNA.
Despite the Supreme Court’s recent ruling on human gene patenting (see entries for 16 June 2013, 13 June 2013, and 28 April 2013 in the media links section of our FYI page on Conversations About a Wiser Use of Our Health Care Dollars & Resources), it is not at all clear what role — if any — money should play in the pursuit of knowledge and our quest to cure cancer.
Millions of Web users already face a similar conundrum when data aggregators (such as Facebook and Google) monetize content created — and given freely — by others.
Who should profit financially from the “donation” of your information — everything from your likes and dislikes to your sequenced DNA — in the new “knowledge economy”?
POSTED 6/26/2013 — The vaccine for human papilloma virus (HPV) is making headlines again, with a new study by the Centers for Disease Control and Prevention showing a 56 percent drop for the HPV infection rate in teenage girls, between the ages of 14 and 19, even though there has been a “very low uptake of the vaccine” in the U.S. The PBS NewsHour reported on the study’s findings
“HPV Vaccine Dramatically Cuts Number of Infections in Teen Girls,” a PBS NewsHour analysis of the issues (originally aired: 20 June 2013)
SUMMARY: “The prevalence of the most common STD — and the leading cause of cervical cancer — among teenage girls has been cut in half, thanks to the HPV vaccine. Margaret Warner talks with Dr. Anne Schuchat of the Centers for Disease Control for more on a new study.”
with the CDC’s director of its Center for Immunization and Respiratory Diseases recommending a more robust HPV vaccination program in the U.S. According to Dr. Schuchat, “We’re vaccinating today in order to prevent cancers that will happen decades from now.”
We think that about 19,000 women gets an HPV-related cancer every year. And ... about 8,000 men get an HPV-related cancer each year.... [T]he most common type of HPV-related cancer in women is cervical cancer.
The most common type of HPV-related cancer in men is throat cancer. So, one thing that we like to say to put this in perspective is, with the level of vaccination coverage we have right now, we are missing the chance to prevent a lot of cancers in girls.
(Dr. Anne Schuchat, PBS NewsHour interview, 20 June 2013)
But the critics are already voicing concern, here and abroad: see the 23 comments (as of 6/26/2013) appended to the PBS NewsHour interview with Schuchat, where one respondent argues “This news was put out to counter the bad news from Japan. ¶ The Japanese health authorities withdrew their recommendation for the HPV vaccines last week due to a pending investigation of serious side effects.”
Here are two English-language reports from the Japanese media on this:
News report in the English-language digital edition of Japan’s largest daily, The Asahi Shimbun, “Health Ministry Withdraws Recommendation for Cervical Cancer Vaccine” (posted 6/15/2013)
“The Ministry of Health, Labor and Welfare is not suspending the use of the vaccination, but it has instructed local governments not to promote the use of the medicine while studies are conducted on the matter.”
“Girls can still receive the vaccination for free, although medical institutions must now inform them beforehand that the ministry does not recommend it.”
Op-ed in Japan’s oldest English language newspaper, The Japan Times, “HPV Vaccine Raises Questions” (posted 6/14/2013)
“The panel’s view is that the side-effect danger from cervical cancer vaccinations is not particularly high compared with that from other vaccinations. If the vaccinations are stopped, many more women may fall victim to cervical cancer. ¶ The health and welfare ministry has the duty to show convincingly that the benefit from the vaccinations is greater than the risks from the vaccinations. Hospitals and doctors need to provide sufficient information to people about the vaccinations so that they can make a rational decision.”
Japan has a long, but little known, record of innovation in cancer research & treatment, dating back to the late 18th century. A digital edition of an illustrated Japanese surgical casebook from this period is available here (Flash player required).
Some introductory description for this casebook, documenting a late 18th-century clinical practice for cancer patients (from the National Library of Medicine’s digital facsimile edition):
“A Surgical Casebook” is a manuscript of hand-painted pictures commissioned by Hanaoka Seishu, a pioneering Japanese surgeon who was the first to use general anesthesia to remove tumors from cancer patients. The colorful, often charming, pictures in this casebook capture the likenesses of the men and women who came to Hanaoka for treatment; and, importantly, they depict, quite graphically, the medical and surgical problem to be treated.
Hanaoka Seishu’s fame is based on his invention of an oral anesthesia that could render a patient unconscious for long enough to allow him to remove deep tumors. Hanaoka was born to a physician’s family in Kii Province (today’s Wakayama Prefecture), a remote, mountainous region of south central Japan, in 1760. At age twenty-two he went to Kyoto, where he studied both traditional Chinese-style medicine and Western-style surgical techniques; at age twenty-five he took over the family business and began to practice an eclectic style of medicine that combined these two traditions. He was greatly concerned with his inability to treat cancer patients, and over a period of twenty years he developed an herbal concoction he called “mafutsusan.” It was made up of several highly toxic plants, including Korean asagao, Japanese aconite, Chinese angelica, and Arisaema japonicum, among others. It did not include opium derivatives which were only beginning to be identified by European doctors. The herbs were ground into a paste, boiled with water, and administered to the patient by mouth well before the surgery. The narcotic effects of this anesthetic could last as long as 24 hours, allowing him to surgically remove many different kinds of tumors which previously had been inoperable.
It’s an impressive manuscript, by any clinical standard.
POSTED 5/15/2013 — I originally intended to write something here about the irrational health care economy (for cancer patients, and for everyone else in the U.S.) back in February 2013 when Time magazine published its cover story by Steven Brill, “Bitter Pill: Why Medical Bills Are Killing Us” (and his related story, “The Profit of Prestigious Cancer Care”).
But I held off, figuring that some impulse control would ensure a more reasoned and hopeful discussion of the issues than I was capable of right then.
A little impulse control is fine & dandy, of course, but hardly enough in this instance. The problems we face are so big and messy and entrenched that it’s quite daunting even to contemplate our situation. Unable to quickly find my way out of the Byzantine maze of self-interest in which U.S. health care providers and consumers are lost, I, like so many others, soon gave up looking, returned to my other work, and hoped that someone else would deal with it.
Fortunately, a few brave souls are doing just that, prompting me to emerge from my research cocoon long enough to launch a new FYI page for Roses with pointers to some of the more intelligent conversations now underway in the media about the out-of-control, soaring health care costs which affect us all.
As I note there, the all-important conversation of ideas is but a prelude to the long slog ahead.
But we won’t get anywhere without it, so I hope Roses visitors will follow up on some of the links given there, then open some conversations of your own about the vexing issues involved.
[ And on a Lighter Note ... ]
The other day I stumbled across a clever poem about rectal cancer, posted on 31 December 2012 to Jemmy Hope’s “Swearing at the Telly” blog: “Cancer’s a Funny Thing,” by the English-Indian geneticist, J. B. S. Haldane (1892–1964).
Among his other achievements, Haldane was the first to estimate the rate of mutation of a human gene. He also studied the behavior of the human body under stress by experimenting on himself, “sometimes in horrendous fashion,” as Issac Asimov relates: “For instance in 1942 he and a companion spent forty-eight hours in a tiny submarine to check whether a particular system for purifying the air supply would work. He also subjected himself to extremes of temperature, carbon dioxide concentration, and so on.” (Asimov’s Biographical Encyclopedia of Science & Technology, 2nd rev. edn., 1982, 736)
This sort of self-experimentation has a long history within British scientific circles, and helps explain Haldane’s mock blazoning of his own cancerous physique in verse.
(Haldane’s mordant wit, on the other hand, is uniquely his. ;-)
POSTED 5/6/2013 — The debate over a federally-mandated Internet sales tax is heating up again, and the PBS NewsHour aired an interesting discussion of the issues on 29 April 2013:
Proposed legislation in Congress could require consumers to pay sales tax for online purchases. Currently, states can only collect taxes from businesses that have a physical presence in their state. Gwen Ifill looks at the stakes and debate with Brian Bieron of eBay and the National Retail Federation’s Rachelle Bernstein.
I’ve added a link to the NewsHour’s video podcast, with HTML transcript and viewer responses directly below, in the media coverage section of our FYI page entitled “Amazon.com Drops Its California-Based Affiliates, Including this Website.”
Also, as it’s been several months since my last post, with no visible activity at this website in the meantime, I probably ought to explain that (as always ;-) there’s plenty going on behind the scenes, with new sections planned for Roses as soon as I can free up the time needed to develop them.
Right now, I am working as hard as I can on dozens of big, complicated research projects.
The downside to this sort of scholarly multi-tasking is that no matter how hard I work, every step forward is followed by two steps back as the amount of archival research required for each project keeps piling on.
The good news is that I continue to find more and more fascinating material on the natural and cultural history of cancer in the 17th century.
And one of these days, it will all be made available here ... I promise!
POSTED 2/5/2013 — This breaking news story from BBC raises several difficult issues about alarmingly-high hysterectomy rates in parts of rural India (“People say that in some places, there are whole districts without uteruses ...”):
“The Indian Women Pushed into Hysterectomies” by Jill McGivering, BBC World Service, Rajasthan (posted to the BBC News Magazine website, 5 February 2013)
Such hasty use of expensive, life-altering surgery to prevent a hypothetical gynecologic cancer is, in my opinion, medical malpractice.
At the very least, such a rush to treatment is unwise, although it can be hard to resist when pushed by medical authorities — especially those brandishing the supposedly “hard evidence” of high-tech imaging — on a woman still reeling from the shock of a dreaded cancer diagnosis, or one who is told “If you don’t get your uterus removed you will get cancer and die.”
As emphasized in the BBC story, the underlying problem is complex (starting with the perverse financial incentives which encourage unnecessary hysterectomies), and multiple approaches must be taken to solve it.
Surely, one such strategy involves better education about gynecologic cancers, their causes & treatments — well beyond popular “awareness” campaigns, which too often alarm people unnecessarily, encouraging the wrong sort of rush to action (or inaction).
Another would involve developing global guidelines for medical “best practices” when it comes to diagnosing and treating gynecologic cancers.
And, if I ran the world, I would post these universal guidelines on every clinic door a woman can enter.
POSTED 12/17/2012 — “Cervical cancer used to kill more women in the United States than any other cancer. Today, deaths in the U.S. are almost unheard of thanks to a decades-old test called a Pap smear, which allows for early detection and treatment.” (“In India, a Secret Weapon Against Cancer: Vinegar,” 12/12/2012 post to The Rundown)
But cervical cancer continues to kill many women in newly-industrializing countries “due to a lack of screening and treatment options that are routine in the developed world.” (U-T San Diego, 12/16/2012, p. A5)
The good news is that clinicians and researchers around the world are aware of this, and are working on the problem, including UCSD specialists in gynecologic oncology who just returned from Senegal, where they installed that nation’s first brachytherapy machine and conducted cervical cancer screenings — using low-tech, low-cost vinegar (acetic acid) instead of a Pap smear for quicker diagnoses, and treating precancerous cells “on the spot with a squirt of liquid nitrogen.” Their Senegalese experience was reported on in the U-T San Diego this weekend:
“UC San Diego Doctor Inspired by Cancer Mission to Africa: Taking Technology to Senegal Leads to Plans for More Help” by Paul Sisson (U-T San Diego [formerly San Diego Union-Tribune], 16 December 2012, p. A5)
Similar innovations in preventing and treating gynecologic cancers have been reported on for India and for Peru, where “One in every 4,000 Peruvian women dies from [cervical cancer] each year, more than breast cancer and lung cancer combined.” To learn more, see:
“In India, a Secret Weapon Against Cancer: Vinegar” by Joanne Silberner and PRI’s The World (posted: 12 December 2012, at 9:50 AM EDT, to The Rundown: A Blog of News and Insight, at the PBS NewsHour website)
“Peru Weighs Low Cost Options to Tackle Deadly Cervical Cancer” by Talea Miller (posted: 25 March 2010, to the PBS NewsHour website)
PBS NewsHour Global Health Unit report from Peru, “Peru Eyes Innovations in Rural Maternity Health” by Ray Suarez (originally aired: 31 March 2010)
[ UPDATE: two more links added on 5/10/2013 ]
PBS NewsHour special report from Senegal, “In Senegal, a Campaign of Education and Dialogue on a Painful Rite of Passage,” by Fred de Sam Lazaro (originally aired: 9 May 2013)
SUMMARY: “Special correspondent Fred de Sam Lazaro reports from the West African nation of Senegal, where some advocates are working to discourage the widespread and painful traditional practice of female circumcision (or genital mutilation) through education and compassionate discussion.”
“Changing Minds in Senegal to Protect Girls From Genital Cutting,” a PBS NewsHour report by Fred de Sam Lazaro, posted to The Rundown: A Blog of News and Insight on 9 May 2013
[ UPDATE: another link added on 6/26/2013 ]
Op-ed by Eric G. Bing, “A Cancer that Need Not Kill: A doctor’s determination, in honor of his mother, is to broaden access to screening for cervical cancer” (Los Angeles Times, 23 June 2013, p. A21)
Dr. Bing is the co-author of Pharmacy on a Bicycle: Innovative Solutions for Global Health and Poverty, and senior fellow and director of global health at the George W. Bush Institute.
He writes here about the recent study from India demonstrating that the “simple vinegar test that costs less than $1 ... can reduce deaths by nearly one third,” proving that “We can defeat cervical cancer now in simple, cost-effective ways.”
“The challenge is access. To save women from cervical cancer, we must strengthen existing systems and shift care to lower-cost providers and settings that are already trusted and know how to overcome cultural barriers. We must create partnerships among governments, businesses, nonprofits, entrepreneurs and women of all ages. And, as my mother’s death taught me, we must mobilize women to recognize their risk and realize that by protecting their health, they can live to protect the ones they love.” (Bing, A21)
[ UPDATE: another link added on 7/6/2013 ]
Op-ed by Charity Wallace, “Women’s Empowerment Key to African Development” (U-T San Diego, 5 July 2013, p. B7)
Wallace is director of the Women’s Initiative at the Bush Institute. She notes here that “Roughly 85 percent of all women diagnosed with cervical cancer every year live in low-income countries — and more than half of those diagnosed with the disease will die from it. ¶ There are innovative public-private partnerships designed to effectively combat female cancers in Africa. The George W. Bush Institute leads an initiative called Pink Ribbon Red Ribbon, which takes a community-centric, results-oriented approach to expanding access to cervical and breast cancer treatments in the developing world. Over the last few years, Pink Ribbon Red Ribbon partners have supported 41,100 pre-cancer screenings and more than 100,000 HPV vaccinations throughout Africa.” (Wallace, B7)
POSTED 12/10/2012 — Last night I saw the world premiere musical, Yoshimi Battles the Pink Robots, at the La Jolla Playhouse (see entry below, dated 11/1/2012, for my initial announcement).
It was a terrific performance ... and an inspired adaptation of The Flaming Lips’ music.
You touched my soul.
Thank you for an unforgettable evening.
POSTED 11/30/2012 — I have added a new FYI page entitled “Protect Yourself against Medical Identity Theft.”
POSTED 11/1/2012 — Ordinarily I shun “war on cancer” metaphors, because I agree with cancer researcher and clinician Guy Faguet that these promote a “pervasive and counterproductive”
parallel with infectious diseases: that cancer cells, like bacteria, are foreign invaders that must be eradicated at any cost. In turn, this has [led] to the development of ever more powerful cytotoxic drugs and increasingly aggressive treatment regimens but few cures.
(Guy B. Faguet, The War on Cancer: An Anatomy of Failure, A Blueprint for the Future, 33)
As Faguet explains, the cellular mutations that produce cancer are not alien invaders, but developmental defects in our own bodies that transform normal tissues into tumors. (If there’s any kind of war involved, it would be a civil war, with all the complexities and cross-purposes such wars usually entail.)
Faguet believes that we’re better off framing cancer as “a genetic cellular dysfunction that can be prevented, detected early, and controlled genetically.” (Faguet, xiv) In sum,
The new paradigm calls upon medical researchers to design means to identify and prevent cancer-causing agents, to develop simple, specific, and cost-effective screening tools for the early detection of all cancers, and to exploit the vast genomic database towards translational therapies for patients with advanced or progressive malignancies. It also calls upon policy makers to enact enlightened public policies towards cancer prevention and screening programs of national scope and achievable goals, and for the NCI to play a pivotal role in steering funding towards prevention, screening, and translational research. At the community level, it urges practitioners to focus on patient — rather than tumor — outcomes, to ensure that potential treatment risks are justified by the probability and magnitude of expected benefits, and to provide maximum pain relief and comfort to terminal patients.
(Faguet, The War on Cancer: An Anatomy of Failure, A Blueprint for the Future, 183)
Nor is Faguet the only one now questioning the failed “War on Cancer” paradigm. The 40th anniversary (in 2011) of the U.S.’s National Cancer Act of 1971 has brought more reappraisals. For example,
“If It’s Not a War on Cancer, What Is It?” by Jason Kane (posted: 23 December 2011, at 9:00 AM EDT, to The Rundown: A Blog of News and Insight, at the PBS NewsHour website)
“The War on Cancer — a Healthy Metaphor?” by Gregory Warner (segment originally aired: 23 December 2011 on Marketplace radio program)
But today, I’m not writing about the ordinary. I want to call attention to an extraordinary artistic endeavor: the upcoming world premiere musical at the La Jolla Playhouse, Yoshimi Battles the Pink Robots, scheduled to run 6 November – 16 December 2012.
The story — written by Wayne Coyne and Des McAnuff, based on music and lyrics by the alternative rock group, The Flaming Lips — concerns a young Japanese-American female artist “fighting for her life” against an aggressive lymphoma. A cancer-as-civil-war metaphor is central to the musical, which delves into a host of big issues relating to love and life in the modern world.
I’ve already bought my ticket, and am looking forward to the high-tech extravaganza (and a rare evening off from work, where I spend too much time battling Internet-spawned robots in a rainbow of colors ... ;-).
Some links where you can learn more:
the U-T San Diego review, “The Fight of Her Life: An Artist Takes On a Deadly Illness in La Jolla Playhouse’s High-Tech ‘Yoshimi Battles the Pink Robots’” by theater critic, James Herbert (U-T San Diego [formerly San Diego Union-Tribune], 28 October 2012, pp. E1, E4)
La Jolla Playhouse Web page for World Premiere Musical: Yoshimi Battles the Pink Robots, where you can still purchase tickets if you’re going to be in the San Diego area
[ UPDATE: two more links added on 11/9/2012 ]
announcement posted on 11/8/2012 to the Voice of San Diego website, “Art and Science Overlap This Weekend” by Kelly Bennett
announcement posted on 11/9/2012 to the KPBS website, “New Musical Based On Flaming Lips Album” by Arts and Culture reporter, Angela Carone
[ UPDATE: two more links added on 1/26/2013 ]
“Review: ‘Yoshimi Battles the Pink Robots’ sounds thrilling, at least: The Flaming Lips-inspired score is the highlight of the literary-challenged ‘Yoshimi Battles the Pink Robots’ at La Jolla Playhouse” by Charles McNulty, Theater Critic for the Los Angeles Times, posted 19 November 2012
Steve Chapple’s “Intellectual Capital” column, “‘Pink Robots’ and Pondering the Future of Biotech,” printed in the 13 January 2013 issue of the U-T San Diego
POSTED 10/14/2012 — The 50th anniversary of the conservationist classic, Silent Spring, occurred on 27 September 2012. Written during 1958–1962 by the marine biologist, Rachel Carson (1907–1964), Silent Spring was first serially published in June 1962 (3 installments, printed in the New Yorker), and then issued in book form 3 months later. With its early warnings about misuse of chemical pesticides, and the consequences of this for human health, Carson’s monograph caused quite a stir, making it “without question one of the landmark books of the twentieth century.” E.g., the conservative magazine, Human Events, gave Silent Spring (along with Darwin’s The Origin of Species) an “honorable mention” in its 2005 ranking of the “Ten Most Harmful Books of the 19th and 20th Centuries.”
In tribute to Silent Spring’s 50th anniversary, supporters and critics alike are taking a new look at the book and its legacy. A January 2012 article in the Journal of Business and Technical Communication (written by Kenny Walker, doctoral student at Arizona, and Lynda Walsh, at the University of Nevada-Reno) inspired a New York Times “Dot Earth” blog entry by Andrew Revkin, “How Rachel Carson Spurred Chemical Concerns by Highlighting Uncertainty,” posted on the book’s anniversary date of 27 September 2012.
Revkin was drawn to Walker and Walsh’s detailed study of Carson’s composing process because of the lessons drawn about Carson’s rhetorical use of scientific uncertainty. As explained by co-author Walker, “Carson adapted and adopted uncertainty from her sources and deliberately used it to provide a site for public participation in scientific debates.” To substantiate this claim, he adds:
These revisions are one example of a strategy we saw Carson use consistently: Add uncertainty at the level of ignorance to destabilize the science, then articulate the harms, hazards, or consequences behind our current actions, and drive it home with a visceral image of risk (which she does in this example through images of liver damage, the accumulation of DDT in milk and butter, and the ability of toxic chemicals to pass to breast-fed human infants, and to a fetus in utero). Other revisions from certainty to uncertainty show up in her direct quotes from soil scientists, and in a section about estrogen and uterine cancer. Only in her last draft does she add: “Although medical opinion is divided on the question, much evidence exists to support the view that similar effects may occur in human tissues.” These additions connect to her general thesis about ignorance and risk: “I do contend that we have put poisonous and biologically potent chemicals indiscriminately into the hands of persons largely or wholly ignorant of their potentials for harm.”
(Kenny Walker on Rachel Carson’s revisions to the chapter on cancer in Silent Spring; posted to the Dot Earth blog on 9/27/2012)
An interesting discussion followed at Dot Earth, which has posted 146 Comments to date (10/14/2012). Among these, I would like here to single out the comment by Carl Safina of Long Island, NY:
In the final analysis, Carson was essentially right. Before her death she consistently emphasized that artificial chemicals had their place but had been overused, and misused, with unintended consequences. The return of birds that had been almost wiped out (Bald Eagles, Ospreys, Peregrine Falcons, others) and the cancer clusters we have now, show, these decades later, that we have produced and misused certain chemicals, with unintended consequences. Remember that Carson simply wrote a book. Evidence accumulated for another decade before Congress (not Rachel Carson) banned DDT and other hard pesticides.
On the question of uses of uncertainty, our perceptions of uncertainly are odd. If you knew there was a 1-in-10 chance of food poisoning in a certain restaurant, you would not go there. Yet many demand--then are confused by--scientific uncertainty.
In my experience scientists usually overstate uncertainty because they are more interested in what we don’t yet know. I think the two best ways to deal with communicating scientific uncertainty are to say either: “Here’s what we know for certain,” and to leave it at that (e.g. the sun is at the center of our solar system, or life evolves), or to say, “Here’s what we know, and here’s what we don’t yet know,” (e.g. this chemical causes cancer in the lab; we don’t yet know how much cancer is caused by this chemical in human or wild animal populations). It’s crucial to be honest and accurate, and it’s as crucial to be clear.
(comment posted to the Dot Earth blog, “How Rachel Carson Spurred Chemical Concerns by Highlighting Uncertainty,” 9/27/2012)
whose call for honesty, accuracy, and clarity in scientific and medical communications I share.
I wish also to direct attention to the response by David Ropeik, author of How Risky Is It, Really?: Why Our Fears Don’t Always Match the Facts (McGraw-Hill, 2010):
You suggest Carson’s openness about uncertainty was honorable. While I agree, it is also likely that she was instinctively using it in the way many people use uncertainty when they want to raise concern. There are indeed passages in Silent Spring to this effect. (I use the book in my course on critical thinking about environmental issues at Harvard.) On p. 40 of my edition, Ch. 2, “Surface Waters and Underground Seas”, she writes about “the impossibility of predicting the composite effect of chemicals...” that build up in the benthic environment; “We don’t begin to know what that is,” said Professor (Rolf) Eliasson (of MIT). “What is the effect on the people? We don’t know.” In the context of the alarming tone of Silent Spring, I would suggest that is not open-mindedness...it’s using uncertainty to make things sound scarier. There are other examples. On the next page she talks about pollution which “is unseen and invisible.” Same thing. Can’t see it? Can’t detect it? That leaves you uncertain, and more afraid.
Uncertainty has been clearly identified by risk perception research as a psychological factor that raises concern. Here’s why. The less we know about how to protect ourselves, the less in control we feel, and the less control we feel, the scarier any risk becomes. Uncertainty can come from not being able to detect a threat (radiation, chemicals, GM ingredients — thus the call for labeling), not understanding a complicated threat (chemicals, radiation) or just not having all the scientific answers yet (Bisphenol A, etc.). In each case, we don’t have all the information we need to know to protect ourselves, which leaves less able to keep ourselves safe...less in control...and more afraid.
For fun, try this little experiment on yourself; Imagine as realistically as possible driving 120 miles an hour...foot mashing the gas pedal to the floor, wind roaring past the car, trees and signs whizzing past in a blur. Now CLOSE YOUR EYES!!!! But keep driving...foot still down on the gas pedal but with your eyes closed. One second, two...five! If you really engage in this exercise you may well have an actual physiological reaction to the sensation of fear it evokes. The exercise demonstrates what it feels like to lose the information you need to protect yourself, so you feel less informed and less able therefore to protect yourself, and more afraid. (The physiological sensation is actually a Fight or Flight response! See Ch. 1 of How Risky Is It, Really?) Welcome to uncertainty as a risk perception factor commonly used by environmentalists, politicians, marketers...anyone who wants you to be afraid.
Uncertainty as corporations use it is different...a form of hiding behind the need for “sound science” and certainty before action is taken, usually regulatory or legal, against any products or processes that MAY be dangerous. It’s an intellectual appeal to reason and fact, as opposed to the visceral appeal to emotion of the ‘be afraid’ application of uncertainty...and that’s why the corporate one doesn’t work — at least on regular folks — as well as the alarmist (Rachel Carson) version.
By the way, this is powerfully relevant for overall risk management policy making. One risk policy making approach is called “hazard based” — if the substance or process in question MAY be a hazard (GMOs, Bisphenol A, etc.) regulate it...Precaution. That’s how Europe is doing things more and more, at least with chemicals and many enviro risks. The other approach to risk management is called “Risk based”, which examines not only whether something may be a hazard but whether we are also exposed, and at what dose, at what age, in what environments, with what effect...all the things you need to calculate whether there is more than something scary but also whether there is likely to be an actual risk...before policy is made.
(comment posted to the Dot Earth blog, “How Rachel Carson Spurred Chemical Concerns by Highlighting Uncertainty,” 9/27/2012)
whose both/and perspective on the rhetoric of Silent Spring leads him to a different conclusion than Walker and Walsh give in their JBTC study.
Ropeik runs his own blog, hosted by Big Think, where he has 3 recent posts that are relevant to those of us communicating about and/or trying to manage intelligently the risks associated with cancer, its prevention and its treatment:
“Silent Spring is 50. The Credit, and the Blame, It Deserves.” (posted 6/19/2012)
“New Evidence about DNA, and Old Patterns of Resistance to New Ideas.” (posted 9/10/2012)
“Facing, and Planning for, How You Will Die (and Why We Don’t).” (posted 8/14/2012)
I have added material from Carson’s still-controversial Silent Spring to Roses’ FYI page on the growing body of evidence connecting cancers to the modern retail economy, including the complete text of her passage on uterine cancer and its environmental connection, as she revised it for publication in 1962.
Within 2 years after Silent Spring’s initial publication in the New Yorker, Rachel Carson died from breast cancer.
POSTED 8/25/2012 — It is with regret — and some surprise — that I announce the end of this website’s affiliation with the indie bookstore, Powell’s City of Books, effective 29 August 2012.
Find out what happened at our new FYI page entitled “Powells.com Drops Its California-Based Partners, Including this Website.”
POSTED 7/14/2012 — The Nation recently ran a great 3-part series on the “avaricious imperium called Amazon,” with articles by Steve Wasserman (editor-at-large for Yale University Press), Michael Naumann (editor-in-chief of the German magazine, Cicero), and Anthony Grafton (Henry Putnam University Professor of History at Princeton University).
All three articles from the 18 June 2012 print issue (vol. 295, no. 25) can be read online at The Nation’s website, and I’ve posted links to them in the media coverage section of our FYI page entitled “Amazon.com Drops Its California-Based Affiliates, Including this Website.”
POSTED 5/21/2012 — There are important new developments in California’s battle with Amazon.com over an Internet sales tax, slated to take effect on 15 September 2012. The latest issue concerns the “sales-tax rebate,” by which Amazon.com (and other retailers) take advantage of state law and the competition between cities vying for new industries to finagle large rebates for themselves, paid for with the very sales taxes intended for local governments and public works. The story was reported on in yesterday’s Los Angeles Times (pp. A1 and A30), where it is noted that
... Once used to attract sizable retailers such as car dealerships, these incentives [sales-tax rebates] are mushrooming as cash-strapped communities compete with one another to land big sales-tax generators.
That arms race is cheating taxpayers, who want their money spent on parks, police and street repairs, said Sen. Mark DeSaulnier (D-Concord), who is considering introducing a bill this session to address the issue.
“It seems like the private sector finds a way to pit one city against the other,” said DeSaulnier, a former city councilman and mayor. “You can’t give away sales tax in this manner.”
This is exactly the kind of economic competition — leading to “arms races” that harm the group, while providing only short-term advantages for individuals, since any gains tend to be relative and mutually offsetting — which Robert Frank warned about in his book, The Darwin Economy: Liberty, Competition, and the Common Good.
You can find more discussion of Frank’s ideas about taming the Darwin economy at our FYI page entitled “Amazon.com Drops Its California-Based Affiliates, Including this Website.”
And, lower down the page, in the section entitled “Related coverage concerning Amazon.com’s ‘Notice of Contract Termination Due to Potential New California Law,’” is a link to the digital edition of Sunday’s Los Angeles Times story, “Amazon Set to Keep Share of State Sales Tax.” I recommend it.
POSTED 5/14/2012 — Having delayed the development of an announcements blog for well over a year, I finally realized that it was my resistance to blogging (and micro-blogging, and social media in general) that was holding me back. It takes a lot of time to properly maintain and moderate a blog — time that I would prefer to spend on other projects. Hence, this weekend, I scrapped my original plans for Roses: The Blog, and am today instituting this simple news page instead. The technology is just a better fit for me ... which means that I can now stop procrastinating, and start reporting on our recent activities.
As always with a complicated website development project such as this, there is lots going on behind the scenes. I am forever tweaking the design and the code in order to keep the site as safe & secure as possible, while still allowing easy access on a wide (and ever-expanding) range of Internet-enabled devices. (I’m already planning for the day when folks use their refrigerators to access one of our physician podcasts, which they listen to while working in the kitchen and making dinner.... ;-)
Of note, I just finished overhauling the entire Roses website — yet again! — along with introducing a new FYI section, which includes pages about: Amazon.com’s battle with California over the new Internet sales tax; the growing body of evidence connecting cancers to the modern retail economy (and what we can do about it, as buyers & sellers); and our experiment with pop-ups, used here as a means for context-sensitive layering of information.
Next up: I need to resolve some problems with our local search engine which, for some of us — not all, apparently — returns garbage characters for typographic quotes and dashes (and other characters outside the core range of ASCII-128) wherever these are used on Roses webpages, which is pretty much everywhere. I have located what I think is the problem (the KSearch engine changes my browser’s default character encoding from Unicode [UTF-8] to Western [ISO-8859-1], whenever I do a search). But I have no idea yet how to fix this ... nor do I even know how widespread the problem is. (E.g., not everyone in the KSearch developer community experiences the problem.) You can help the troubleshooting process along by letting us know if our local KSearch tool works properly when you use it, or not.
Once this issue is resolved, I plan to return to working on the new History section I’m developing for Roses. I have lots of material (all of it original archival research) to post about the prevalence and treatment of cancers, especially gynecologic cancers, in the 17th century. The research has antiquarian value in its own right, of course, but I also find that such historical juxtapositions offer a useful way of thinking about the evolution of cancer and its treatment in the 21st century. So I am excited about the unique historical resources we’ll be able to make available at Roses, and I hope others will be, too.
There is a lot more in the works, but I don’t want to get too far ahead of myself. This news page is intended to document more immediate actionable items & achievements — what’s actually doable within the next several months.
As such, it will help track our progress, and hopefully, provide an occasional sense of accomplishment — something that is too often lacking for those of us engaged in the Sisyphean task of digital-media content creation and website development!
(Founder, Publisher & Editor of Roses.CommunicatingByDesign.com)
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